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目的探讨无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)急性加重期患者的疗效,并调查其医疗费用。方法选择我院收治的COPD急性加重期伴有Ⅱ型呼吸衰竭患者121例,分为两组:对照组(59例)为2001～2002年收治的以药物治疗为主者。治疗组(62例)为2003年至2005年收治的以无创正压通气加药物治疗者。观察两组治疗前后的呼吸频率、心率、肺部啰音和动脉血气等指标.比较两组患者的平均住院天数及药物、无创呼吸机通气、普通病房、ICU病房、护理和总住院费用。结果二组患者在治疗后其呼吸频率、心率、肺部啰音均有所改善,以治疗组改善明显,两组比较有显著性差异(P<0.05)。治疗组接受无创双水平正压通气(BiPAP)治疗结束时(低流量吸氧、自主呼吸4h以上)患者动脉血气显著改善(P<0.05)。治疗组的平均住院天数(13d)较对照组(21d)短。治疗组的ICU病房费用、护理费用、药物治疗费用及住院总治疗费用均较对照组少,两组比较有显著性差异[治疗组分别为(600±200)元,(117±27)元,(3546.2±359.4)元,(8079.42±1153.27)元,对照组分别为(1600±400)元,(207±36)元,(4673.5±396.4)元,(8925.12±1063.42)元,P<0.05]。结论无创正压通气治疗COPD急性加重期合并呼吸衰竭的疗效是肯定的。同时缩短了平均住院天数,降低平均总住院费用。
Objective To investigate the efficacy of noninvasive positive pressure ventilation (NIPPV) in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and to investigate their medical costs. Methods A total of 121 patients with type Ⅱ respiratory failure who were admitted to our hospital with acute exacerbation of COPD were divided into two groups: the control group (59 cases) were mainly treated with drugs from 2001 to 2002. The treatment group (62 cases) was treated with noninvasive positive pressure ventilation plus drug therapy from 2003 to 2005. The respiratory rate, heart rate, pulmonary rales and arterial blood gas were measured before and after treatment in the two groups.The mean length of stay and medication, noninvasive ventilator ventilation, general ward, ICU ward, nursing and total hospitalization were compared between the two groups. Results The respiratory rate, heart rate and pulmonary rales of the two groups improved after treatment, and the improvement was obvious in the treatment group. There was significant difference between the two groups (P <0.05). Arterial blood gas was significantly improved (P <0.05) in patients treated with BiPAP at low flow oxygenation and spontaneous breathing for more than 4 hours. The average length of stay in the treatment group (13 days) was shorter than that in the control group (21 days). The ICU ward cost, nursing cost, drug treatment cost and total hospitalization cost in the treatment group were less than those in the control group. There were significant differences between the two groups [treatment group was (600 ± 200) yuan, (117 ± 27) yuan, (P <0.05) in the control group were (1600 ± 400) yuan, (207 ± 36) yuan, (4673.5 ± 396.4) yuan and (8925.12 ± 1063.42) yuan respectively, . Conclusion The efficacy of noninvasive positive pressure ventilation in the treatment of acute exacerbation of COPD combined with respiratory failure is affirmed. At the same time shorten the average length of stay, reduce the average total cost of hospitalization.