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目的研究无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性发作期(AECOPD)并重度二氧化碳潴留患者的效果及安全性。方法 41例经NPPV治疗的AECOPD并呼吸衰竭患者,根据动脉血二氧化碳分压(Pa CO2)潴留程度分为重度二氧化碳潴留组(A组)和轻中度二氧化碳潴留组(B组)。其中A组17例,Pa CO2≥80 mm Hg(1 mm Hg=0.133 k Pa),平均(90.2±9.8)mm Hg;B组24例,50 mm Hg≤Pa CO2<80 mm Hg,平均(68.2±6.3)mm Hg。对比分析两组患者NPPV治疗后2、24、48 h生命体征及动脉血气变化,并观察其并发症情况。结果两组患者NPPV治疗后2、24、48 h时p H值及动脉血氧分压(Pa O2)均较治疗前显著升高(P<0.05),Pa CO2显著下降(P<0.05);但两组患者疗效及并发症发生率组间比较差异未见统计学意义(P>0.05)。结论 NPPV对AECOPD并重度二氧化碳潴留患者有较好的救治效果及相对安全性。
Objective To investigate the efficacy and safety of noninvasive positive pressure ventilation (NPPV) in patients with acute episode of chronic obstructive pulmonary disease (AECOPD) and severe carbon dioxide retention. Methods Forty-one patients with AECOPD and respiratory failure who were treated with NPPV were divided into two groups: severe carbon dioxide retention group (group A) and mild to moderate carbon dioxide retention group (group B) according to the degree of arterial carbon dioxide (PaCO 2) retention. There were 17 cases in group A, Pa CO2≥80 mm Hg (1 mm Hg = 0.133 k Pa), mean (90.2 ± 9.8) mm Hg in group A, 24 cases in group B, 50 mm Hg≤Pa CO2 <80 mm Hg, ± 6.3) mm Hg. The changes of vital signs and arterial blood gases at 2, 24, 48 h after NPPV treatment were compared between the two groups and the complications were observed. Results The values of p H and Pa O2 at 2, 24 and 48 h after NPPV treatment in both groups were significantly higher than those before treatment (P <0.05) and Pa CO2 significantly decreased (P <0.05). However, there was no significant difference between the two groups in efficacy and complication rate (P> 0.05). Conclusion NPPV has a good therapeutic effect and relative safety on patients with AECOPD and severe carbon dioxide retention.