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目的评价双水平无创正压通气(BiPAP)治疗老年慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床疗效。方法87例60岁以上COPD合并Ⅱ型呼吸衰竭患者,分为治疗组41例和对照组46例,两组均给予常规药物治疗,治疗组同时给予BiPAP无创通气治疗。结果BiPAP耐受良好的26例患者,治疗后其动脉血氧分压(PaO2)和二氧化碳分压(PaCO2)较治疗前明显改善(P<0.01);与对照组比较,平均住院天数缩短(P<0.05)、血气改善时间提前(P<0.01)、血气改善程度更好(P<0.05);BiPAP治疗还可以减慢呼吸频率和心率(P<0.01),而对患者血压水平无明显影响(P>0.05);且无1例发生腹胀、面部皮肤压伤、气压伤或呼吸机相关肺炎。结论经鼻罩BiPAP无创通气是治疗老年COPD合并Ⅱ型呼吸衰竭的一种安全有效的方法。
Objective To evaluate the clinical efficacy of bi-level noninvasive positive pressure ventilation (BiPAP) in the treatment of senile chronic obstructive pulmonary disease (COPD) with type Ⅱ respiratory failure. Methods A total of 87 patients with COPD and type Ⅱ respiratory failure over the age of 60 were divided into treatment group (n = 41) and control group (n = 46). Both groups were given conventional medical treatment. The treatment group was treated with BiPAP noninvasive ventilation. Results In 26 patients with well-tolerated BiPAP, PaO2 and PaCO2 were significantly improved after treatment (P <0.01). Compared with the control group, the mean length of hospital stay (P (P <0.01). The improvement of blood gas was better (P <0.05). BiPAP treatment also slowed the respiratory rate and heart rate (P <0.01), but had no significant effect on the blood pressure level (P < P> 0.05). No one had abdominal distension, facial skin crush, barotrauma or ventilator-associated pneumonia. Conclusion Noninvasive ventilation via nasal mask BiPAP is a safe and effective method for the treatment of elderly COPD with type Ⅱ respiratory failure.