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目的:观察无创正压通气(NIPPV)治疗急性脑卒中合并慢性阻塞性肺疾病(COPD)呼吸衰竭的临床疗效。方法:分析67例急性脑卒中合并COPD呼吸衰竭(急性脑卒中+COPARF组)、59例急性脑卒中合并中枢性呼吸衰竭(急性脑卒中+CRF组)和65例COPD合并呼吸衰竭(对照组)患者应用BiPAP呼吸机治疗的疗效。对治疗前和治疗后1~6 h生命体征和动脉血气分析的变化及3组患者病死率、治疗有效平均通气时间、存活者和病死者的平均机械通气时间进行统计学分析。结果:急性脑卒中+COPARF组、急性脑卒中+CRF组和对照组的治疗有效率分别为71.64%、30.50%和72.30%;急性脑卒中+COPARF组疗效和对照组比较,差异无统计学意义(P>0.05);急性脑卒中+CRF组疗效与另2组比较,差异有显著统计学意义(P<0.01)。病死率分别为22.38%、45.76%和15.38%;急性脑卒中+COPARF组病死率与对照组比较,差异无统计学意义(P>0.05);急性脑卒中+CRF组病死率与另2组比较,差异有统计学意义(P<0.01)。治疗有效平均通气时间,急性脑卒中+COPARF组与对照组比较和急性脑卒中+CRF组与另2组比较,均差异有统计学意义(P<0.05)。急性脑卒中+COPARF组存活者的平均机械通气时间、病死者生前平均使用机械通气时间与另2组比较,均差异有统计学意义(P<0.05)。结论:NIPPV治疗急性脑卒中合并COPD呼吸衰竭患者的临床疗效肯定。
Objective: To observe the clinical effect of noninvasive positive pressure ventilation (NIPPV) on respiratory failure in patients with acute stroke and chronic obstructive pulmonary disease (COPD). Methods: A total of 67 acute stroke patients with COPD respiratory failure (acute stroke + COPARF group), 59 acute stroke patients with central respiratory failure (acute stroke + CRF group), and 65 COPD patients with respiratory failure (control group) Therapeutic efficacy of BiPAP ventilator in patients. The change of vital signs and arterial blood gas analysis before treatment and 1 ~ 6 h after treatment and the mortality, treatment effective ventilation time, average mechanical ventilation time of survivors and those who died were statistically analyzed. Results: The effective rates of acute stroke + COPARF group, acute stroke + CRF group and control group were 71.64%, 30.50% and 72.30% respectively. There was no significant difference between acute stroke + COPARF group and control group (P> 0.05). There was a significant difference between the two groups in acute stroke and CRF (P <0.01). The case fatality rate was 22.38%, 45.76% and 15.38% respectively. There was no significant difference in the mortality rate between acute stroke + COPARF group and control group (P> 0.05). The mortality rate of acute stroke + CRF group was compared with the other two groups , The difference was statistically significant (P <0.01). The mean effective ventilation time, acute stroke + COPARF group and control group and acute stroke + CRF group compared with the other two groups, the difference was statistically significant (P <0.05). The average time of mechanical ventilation in survivors of acute stroke + COPARF group and the mean duration of mechanical ventilation in the deceased were significantly different from those in the other two groups (P <0.05). Conclusion: The clinical efficacy of NIPPV in patients with acute stroke complicated by respiratory failure of COPD is positive.