无创正压通气治疗COPD急性加重导致高碳酸血症临床探究.doc

无创正压通气治疗COPD急性加重导致高碳酸血症临床探究【摘要】 目的 对比无创正压通气(NPPV)对慢性阻塞性肺疾病(COPD)急性加重导致轻中度高碳酸血症与重度高碳酸血症的疗效。方法 对比入选COPD急性加重导致轻中度高碳酸血症(PaCO280 mmHg)组患者NPPV 2 h后pH值和PaCO2的变化、24 h后pH值恢复正常的人数、总的NPPV治疗时间和住院天数。结果 轻中度高碳酸血症组44人,重度高碳酸血症组42人。轻中度高碳酸血症组和重度高碳酸血症组相对比,NPPV 2 h后pH值(分别为0.04±0.01和0.06±0.03,P=0.63)和PaCO2[分别为(14.3±7.4)mmHg和(18.1±11.2)mmHg,P=0.34]的改善程度相似。对比两组患者NPPV 24 h后pH值恢复正常比率(分别为65.9%和59.5%,P=0.65)、NPPV应用时间[分别为(103±8.1)h和(106±6.6)h,P=0.74]、住院天数[分别为(13±2.7)d和(15±4.1)d,P=0.53]及NPPV失败率(分别为13.6%和19.0%,P=0.56)也无差异。结论 NPPV治疗对COPD急性加重导致重度高碳酸血症的患者是有效的。 【关键词】 无创正压通气;慢性阻塞性肺疾病;高碳酸血症 【Abstract】 Objective To compare the curative effects between mild-moderate hypercapnia and severe hypercapnia caused by acute exacerbations of chronic obstructive pulmonary disease treated with noninvasive positive pressure ventilation(NPPV).Methods Patients with mild-moderate hypercapnia(PaCO280 mmHg)caused by acute exacerbations of chronic obstructive pulmonary disease were enrolled.The pH value and PaCO2 2 h after NPPV,number of patients with normal pH value 24 h after NPPV,treatment time and hospital day were observed.Results Forty four patients with mild-moderate hypercapnia and forty two severe hypercapnia.There were no significant difference of the pH value(0.04±0.01 vs 0.06±0.03,P=0.63) and PaCO2(14.3±7.4 vs 18.1±11.2 mmHg,P=0.34)2 h after NPPV,proportion of patients with normal pH value(65.9% vs 59.5% respectively,P=0.65)24 h after NPPV,treatment time(103±8.1 vs 106±6.6 h,P=0.74)and hospital day(13±2.7 vs 15±4.1 days,P=0.53)between the two groups.Conclusion NPPV is effective in the treatment of severe hypercapnia caused by acute exacerbations of COPD. 【Key words】 Noninvasive positive pressure ventilation;Chronic obstructive pulmonary disease;Hypercapnia 无创正压通气(noninvasive positive pressure vebtilation,NPPV)被用来治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重所致的高碳酸血症已得到广泛的认可,它是常规治疗(控制性氧疗、支气管扩张剂、抗感染药物和类固醇激素)的重要辅助治疗措施。研究发现[1]:对COPD急性加重的患者,特别是二氧化碳潴留的,NPPV可明显降低其死亡率、气管插管率和住院时间。 NPPV治疗前的动脉血