BiPAP通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭临床研究.docVIP

BiPAP通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭临床研究 　　[摘要]目的探讨双水平无创正压通气(BiPAP)治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者的疗效。方法 87例慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的患者随机分为时照组(43例)和试验组(44例)。在常规治疗的基础上,对照组给予低流量吸氧(2-5L/min),试验组接受BiPAP呼吸机治疗。在治疗前、治疗后24h及72h分别记录心率(HR)、呼吸频率(RR)及动脉血气指标(pH、PaCO2、PaO2)。结果 BiPAP通气治疗24h和72h后,试验组pH和PaO2较治疗前明显升高(P 　　[关键词]双水平正压通气; 慢性阻塞性肺疾病; 呼吸衰竭 　　[中图分类号]R563.8[文献标识码]A [文章编号] 1005-0515(2010)-8-018-02 　　A clinical study of bi-leve positive airway pressure on patients with chronic obstructive pulmonary 　　disease complicated typeⅡ respiratory failure 　　MIAO Feng-binGUAN Yun-li 　　(Respiratory Department,the People,s Hospital of weiyuan county in Sichuan Province,642450,China) 　　[Abstract]ObjectiveTo explore the effect of bi-leve positive airway pressure(BiPAP) ventilation on the patients with chronic obstructive pulmonary diseas complicated typeⅡ respiratory failure. Methods Eighty-seven patients with chronic obstructive pulmonary diseas complicated typeⅡ respiratory failure were randomly divided into test group(44 cases)and control group(43 cases).Besides conventional treatments,the control group received routine oxygen therapy(2-5 L/min) and the test group received bi-level positive airway pressure(BiPAP)ventilation.The heart rate(HR),respiratory rate(RR), and arterial blood gas parameters(pH,PaCO2,PaO2)were recorded before and 24h, 72h after treatment. Results After 24h 、72h of BiPAP ventilation,the values of pH and PaO2 improved significantly and the values of HR ,RR and PaCO2 decreased obviously in the test group than those before treatment or those in the control group at same stage(P50mm Hg,PaO2 　　3讨论 　　本实验通过实验组和对照组在治疗前后心率、呼吸频率及血气分析变化的比较,可以看出BiPAP治疗可明显提高PaO2、降低PaCO2,呼吸衰竭症状很快缓解。BiPAP通气疗效确切,可有效增加通气量,改善肺的通气和换气功能障碍,纠正呼吸衰竭,改善病情。 　　慢性阻塞性肺疾病急性加重期患者常因肺部感染、呼吸肌疲劳及电解质紊乱等因素使气道内分泌物??多,且支气管出现痉挛,加之肺组织弹性下降,患者气道陷闭,动态肺过度扩张,往往造成气道阻力增加和内源性呼气末正压(PEEPi)形成,从而使患者呼吸肌作功及耗氧量增加并加重呼吸肌疲劳。同时,肺泡通气不良尚会加重换气功能障碍,从而使PaO2进一步下降, PaCO2升高,发生不同程度的低氧血症和高碳酸血症,最终出现Ⅱ型呼吸衰竭,甚至出现意识障碍。如未及时采取有效措施增加通气量,纠正低氧血症和高碳酸血症,则可能危及患者生命。 　　BiP