应用无创和有创机械通气治疗肺性脑病的临床疗效分析.docVIP

应用无创和有创机械通气治疗肺性脑病的临床疗效分析 刁鑫，杨岚 （西安交通大学医学院第一附属医院呼吸内科，陕西，西安 710061） [摘要] 目的 分析无创机械通气和有创机械通气治疗慢性阻塞性肺疾病（COPD）并发肺性脑病的疗效。方法 回顾分析我科2010年1月到2011年6月收治的COPD合并肺性脑病的患者，选取采用机械通气治疗的患者，根据机械通气的方式不同分为无创组和有创组，分析两组的治疗效果。结果 两组治疗后在血气分析上均明显改善，但有效率和死亡率无统计学差异，同时无创组的并发症明显低于有创组。结论 对COPD合并肺性脑病的患者治疗上首选机械通气治疗，并且无创机械通气并不是绝对禁忌症，值得推广。 [关键词] 慢性阻塞性肺疾病；肺性脑病；机械通气 Clinical analysis of noninvasive mechanical ventilation versus invasive mechanical ventilation to treat hypercapnic encephalopathy in chronic obstructive pulmonary disease(COPD) [Abstract] Objective This study analysed the outcomes of noninvasive mechanical ventilation versus invasive mechanical ventilation in COPD exacerbations with hypercapnic encephalopaphy.Methods This study reviewed the patents with hypercapnic encephalopaphy due to COPD that all were treated by mechanical ventilation in the respiratory department between January 2010 to June 2011.According to the different way of mechanical ventilation,these patients were divided into 2 groups,the noninvasive group and invasive group.And the outcomes of the 2 groups were analysed and compared.Result ABG significantly improved in Both groups after mechanical ventilation.The effective rate and mortality were similar in the 2 groups.But the complications of noninvasive group were less than invasive group.Conclusion Mechanical ventilaton is the first choice for the treatment of COPD with hypercapnic encephalopaphy that is not the absolute contraindication to noninvasive mechanical ventilation.Noninvasive mechanical ventilation is well worth recommending to the patients of COPD with hypercapnic encephalopaphy. [keyword] COPD,；hypercapnic encephalopaphy；mechanical ventilaton 慢性阻塞性肺疾病（COPD）是呼吸系统最常见的慢性疾病，人群中发病率高，对生活质量影响大，社会负担重，并且容易合并呼吸衰竭和肺性脑病等严重的并发症，已经成为呼吸内科最多见的危重症。肺性脑病即由于缺氧和二氧化碳潴留而出现的各种神经、精神症状的临床综合征。由于其病情重、发展快，一般认为对于肺性脑病的治疗应该尽早机械通气并且应给予气管插管连接呼吸机辅助通气，而因为意识障碍和排痰能力差等因素是使用无创正压通气（NPPV）治疗的禁忌症[1-6]。但是近期我们在临床上也经常可以看到一些出现嗜睡、瞻望甚至昏迷的肺性脑病患者，因家属拒绝气管插管而采用无创机械通气治疗。治疗后很多患者能够缓解症状，恢复意识，并成功撤离呼吸机。也有一些文章证明严重肺性脑病患