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目的 探讨鼻塞法低负压吸出技术 (NASPI)对COPD急性期并Ⅱ型呼吸衰竭 (呼衰 )患者二氧化碳的清除作用及其对病情的影响。方法 4 0例COPD急性期并Ⅱ型呼衰患者分为NASPI治疗组和呼吸兴奋剂治疗 (对照 )组 ,每组 2 0例。 4 0例均常规给予 2 5 %氧疗、抗感染、茶碱解痉和对症支持治疗。NASPI组加用鼻塞法清肺仪中档 (以 32 0～ 4 0 0Pa的负压每分钟吸出约 15 0 0ml气体的速度 )治疗 2h ,期间氧疗浓度改为 2 9% ;对照组则加用可拉明 2 .5 μg/min和洛贝林 2 0 μg/min持续静脉点滴 2 4h ,治疗前后均抽动脉血进行血气分析 ,并记录症状。结果 NASPI可明显降低患者动脉血二氧化碳分压 (PaCO2 )水平 (P <0 .0 0 1) ,NASPI对二氧化碳的清除效果优于呼吸兴奋剂 ;而且NASPI治疗后患者咳痰增多且易咳出。NASPI加氧疗可使PaO2 和SaO2 显著升高 (分别为P <0 .0 1)。NASPI可使PH值有所升高但不显著 (P >0 .0 5 )。NASPI治疗时部分患者感咽喉部干燥不适。结论 NASPI能有效地降低COPD急性期Ⅱ型呼衰患者的PaCO2 ,并使患者咳痰增多且易咳出 ,方法简便、安全、实用。
Objective To investigate the effect of nasal obstruction with low negative pressure aspiration (NASPI) on carbon dioxide scavenging in COPD patients with acute respiratory failure (Ⅱ) and type Ⅱ respiratory failure (respiratory failure) and its effect on the disease. Methods Twenty-four patients with acute COPD and type Ⅱ respiratory failure were divided into NASPI treatment group and respiratory stimulant treatment group (control group), 20 in each group. 40 cases were routinely given 25% oxygen therapy, anti-infection, theophylline antispasmodic and symptomatic and supportive treatment. NASPI group plus nasal congestion method of lung-defroster mid-range (at a negative pressure of 32 0 ~ 400 Pa suction about 150 ml gas per minute speed) for 2h, the oxygen therapy concentration was 29%; control group was added 2.5 mmol / L of mitomycin and 20 μg / min of lobeline were given intravenously for 24 hours. Before and after treatment, blood was collected for blood gas analysis and the symptoms were recorded. Results NASPI significantly decreased the PaCO2 level (P <0.01). NASPI showed better effect on removing carbon dioxide than respiratory stimulant. Nasopharyngeal mucosa sputum increased and cough easily after NASPI treatment. NASPI plus oxygen therapy significantly increased PaO2 and SaO2 (P <.01, respectively). NASPI can make the PH value increased but not significant (P> 0.05). Some patients with throat and throat discomfort during NASPI treatment. Conclusions NASPI can effectively reduce PaCO2 in COPD patients with type Ⅱ respiratory failure and increase sputum in patients with cough. The method is simple, safe and practical.