论文部分内容阅读
目的比较无创双水平正压通气(BiPAP)平均容积保证压力支持(AVAPS)模式与同步/时间控制(S/T)模式在肥胖的慢性阻塞性肺疾病(COPD)患者并发急性Ⅱ型呼吸衰竭中的治疗作用。方法选取2012年3月-2013年6月入院治疗且体质量指数(BMI)>25 kg/m2的COPD发生急性Ⅱ型呼吸衰竭患者36例,按数字随机表法分为AVAPS组与S/T组。两组的基础治疗相同,AVAPS组采用飞利浦伟康V60呼吸机BiPAP AVAPS模式进行无创通气治疗,S/T组采用相同机型BiPAP S/T模式治疗。分别比较两组患者治疗1、6、24、72 h的格拉斯高昏迷(GCS)评分变化、血气分析结果、呼吸机监测数据。结果 AVAPS组患者在最初治疗的6 h内GCS评分高于S/T组[1 h(:13.2±0.6)、(11.9±0.6)分,P<0.05;6 h(:13.8±0.5)、(12.1±0.6)分,P<0.05];24 h内的动脉血气酸碱度pH值改善[1 h:7.31±0.03、7.26±0.02,P<0.05;6 h:7.37±0.05、7.31±0.04,P<0.05];24 h:7.40±0.04、7.33±0.03,P<0.05]及二氧化碳分压下降[1 h:(65.2±5.1)、(69.5±4.1)mm Hg(1 mm Hg=0.133 kPa),P<0.05;6 h(:61.4±4.2)(、66.7±4.3)mm Hg,P<0.05;24 h(:58.2±4.5)(、64.3±5.4)mm Hg,P<0.05)]优于S/T组,24 h内浅快呼吸指数低于S/T组[1 h:(35.2±8.1)、(62.8±13.2)次/(min·L),P<0.05];6 h(33.4±7.8)、(54.8±11.6)次/(min·L),P<0.05],同时,减少了额外的人工参数调整次数[3.4±1.1、1.2±0.6),P<0.05]。结论对超重的COPD合并急性Ⅱ型呼吸衰竭患者采用AVAPS模式进行无创通气治疗,较S/T模式能更快地恢复意识水平,更快地降低血二氧化碳分压、改善pH值,同时减少了呼吸治疗师的人工操作次数。
Objective To compare the effects of noninvasive bi-level positive airway pressure (BiPAP) AVAPS and S / T mode in patients with obesity and chronic obstructive pulmonary disease (COPD) complicated by acute type Ⅱ respiratory failure Therapeutic effect. Methods Thirty-six patients with acute respiratory failure type Ⅱ of COPD admitted to hospital from March 2012 to June 2013 with body mass index (BMI)> 25 kg / m2 were divided into AVAPS group and S / T group. The two groups of the same basic treatment, AVAPS group with Philips Weikang V60 ventilator BiPAP AVAPS mode non-invasive ventilation treatment, S / T group using the same model BiPAP S / T mode treatment. The changes of Glasgow coma (GCS) scores, blood gas analysis results and ventilator monitoring data were compared between the two groups at 1, 6, 24 and 72 h after treatment. Results The GCA score of patients in AVAPS group was significantly higher than that in S / T group within 6 h of initial treatment [1 h (13.2 ± 0.6), (11.9 ± 0.6), P <0.05; 6 h (13.8 ± 0.5) 12.1 ± 0.6), P <0.05]. The pH value of arterial blood gas pH within 24 h was improved [1 h: 7.31 ± 0.03,7.26 ± 0.02, P <0.05; 6 h: 7.37 ± 0.05,7.31 ± 0.04, P < 0.05); 24 h: 7.40 ± 0.04, 7.33 ± 0.03, P <0.05] and partial pressure of carbon dioxide decreased 1 h: (65.2 ± 5.1), (69.5 ± 4.1) mm Hg (1 mm Hg = 0.133 kPa) P <0.05; 6 h: 61.4 ± 4.2, 66.7 ± 4.3 mm Hg, P <0.05; 24 h: 58.2 ± 4.5, 64.3 ± 5.4 mm Hg, P < (P <0.05); 6 h (33.4 ± 7.8), T (P <0.05); T ), (54.8 ± 11.6) times /(min·L),P<0.05], while reducing the number of additional manual parameter adjustments [3.4 ± 1.1, 1.2 ± 0.6, P <0.05]. Conclusions Noninvasive ventilation with AVAPS mode in patients with overweight COPD and acute respiratory failure type Ⅱ can restore consciousness faster than S / T mode, lower blood pressure of carbon dioxide more quickly, improve pH value and reduce respiration Number of therapist’s manual operations.