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目的 探讨无创正压通气 (NPPV)治疗有反复气管插管及机械通气史的慢性肺心病患者急性加重期的临床疗效和安全性。方法 对 33例曾接受过 2～ 5次气管插管的慢性肺心病急性加重期患者以双水平正压通气 (BiPAP)方式进行NPPV治疗。结果 33例中 2 0例(6 0 6 % )好转 ,其临床症状及血气分析指标明显改善 ,其中 1 5例在肺心病急性加重 2天内实施NPPV。 1 3例 (39 4 % )因病情恶化需要气管插管而进行有创机械通气治疗。NPPV治疗期间的并发症包括明显胃胀气 (8例 )及低氧血症和高碳酸血症加重 (5例)。结论 对于多数自主呼吸相对稳定的有反复气管插管及机械通气史的慢性肺心病急性加重期患者 ,NPPV治疗有效 ,且并发症少 ,但需做好气管插管准备
Objective To investigate the clinical efficacy and safety of noninvasive positive pressure ventilation (NPPV) in the treatment of patients with chronic cor pulmonale with repeated episodes of tracheal intubation and mechanical ventilation. Methods Thirty-three patients with acute exacerbation of chronic pulmonary heart disease who had received intratracheal intubation of 2 to 5 times were treated with NPPV by bi-level positive pressure ventilation (BiPAP). Results Twenty-three (60.6%) of the 33 patients improved, and their clinical symptoms and blood gas analysis indexes were significantly improved. Among them, 15 patients were NPPV within 2 days of exacerbation of pulmonary heart disease. Thirteen patients (39.4%) had invasive mechanical ventilation due to endotracheal intubation due to worsening conditions. Complications during NPPV included significant flatulence (n = 8) and hypoxemia and hypercapnia (n = 5). Conclusion For the majority of spontaneous respiration is relatively stable in patients with recurrent tracheal intubation and mechanical ventilation in patients with chronic exacerbation of chronic pulmonary heart disease, NPPV treatment and less complications, but the need for tracheal intubation to be prepared