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目的观察早期使用NIPPV对AECOPD的血气分析,氧合指数的变化、气管插管上有创呼吸机比率及住院病死率等的影响。方法84例入住呼吸科的AECOPD患者[pH<7.35,动脉血二氧化碳分压(PaCO2)大于50mmHg(1mmHg=0.133kPa)]。入选病例随机分常规治疗+NIPPV治疗组(A组,n=44例)和常规治疗组(B组,n=40例)观察两组患者治疗前后0、2、24和72h及出院时动脉血气分析、呼吸频率(RR)、心率(HR)的变化及氧合指数的变化,比较两组气管插管上有创呼吸机比率及住院病死率、平均住院日的改变。结果NIPPV组PaO2、PaCO2、RR、HR、氧合指数治疗前后均有显著改善,pH值治疗前后比较有下降趋势;常规治疗组PaCO2、氧合指数改变各组间的比较,差异无显著性;平均住院日NIPPV组显著低于常规治疗组(P=0.004),而气管插管上呼吸机比率有降低趋势。结论AECOPD患者在常规治疗的基础上,早期应用NIPPV可明显改善气体交换,缓解呼吸肌疲劳,减少住院天数。
Objective To observe the effects of early use of NIPPV on AECOPD in blood gas analysis, changes in oxygenation index, invasive ventilator rate in tracheal intubation and hospital mortality. Methods Eighty-four AECOPD patients admitted to the respiratory department [pH <7.35, PaCO2> 50 mmHg (1 mmHg = 0.133 kPa)] were included. The patients were randomly divided into routine treatment + NIPPV treatment group (n = 44 in group A) and routine treatment group (n = 40 in group B). The arterial blood gases at 0, 2, 24 and 72 hours before and after treatment were observed in two groups Analysis of changes in respiratory rate (RR), heart rate (HR) and oxygenation index changes, tracheal intubation rate of invasive ventilator and hospital mortality, the average length of stay changes. Results The PaO2, PaCO2, RR, HR and oxygenation index in NIPPV group were significantly improved before and after treatment, and the pH values were decreased before and after treatment. PaCO2 and oxygenation index in the routine treatment group were not significantly different among the groups. The mean hospital stay was significantly lower in the NIPPV group than in the conventional treatment group (P = 0.004), while the rate of intubation of the upper ventilator decreased. Conclusion AECOPD patients on the basis of conventional treatment, early application of NIPPV can significantly improve gas exchange, relieve respiratory muscle fatigue, reduce the number of days of hospitalization.