BiPAP联合振动排痰治疗AECOPD合并呼吸衰竭效果评价.docVIP

BiPAP联合振动排痰治疗AECOPD合并呼吸衰竭效果评价 　　[摘要] 目的 探讨无创双水平气道正压通气联合振动排痰治疗慢性阻塞性肺疾病合并呼吸衰竭的临床效果。 方法 将40例患者随机分为A组与B组各20例。A组患者采用无创双水平正压通气联合振动排痰进行治疗，B组患者仅使用无创双水平正压通气治疗，观察两组的治疗效果。 结果 A组患者的PaCO2较B组下降快（P 　　[关键词] 无创正压通气；振动排痰；慢性阻塞性肺疾病急性发作 　　[中图分类号] R563[文献标识码] A[文章编号] 1674-4721（2014）06（a）-0030-03 　　 　　Effect of Bi-level positive airway pressure combined with vibration sputum elimination in the treatment of chronic obstructive pulmonary disease with acute exacerbation complicatedwith respiratory failure 　　LI Hai-quan ZHAO Jie WANG Hai-qing XU Jun-ma DU Yong-liang LI Hui-ting 　　Department of Respiratory,the Second Affiliated Hospital of Xuzhou Medical College,Xuzhou 221006,China 　　[Abstract] Objective To evaluate the efficacy of Bi-level positive airway pressure (BiPAP) combined with vibration sputum elimination in the treatment of chronic obstructive pulmonary disease with acute exacerbation (AECOPD) complicatedwith respiratory failure. Methods 40 cases of patients with respiratory failure were randomly divided into group A (20 cases) and group B (20 cases).The patients in group A were received noninvasive BiPAP ventilation and vibration sputum elimination.The patients in group B were treated with BiPAP ventilation only.Clinical effect in two groups were observed. Results After treatment,PaCO2 changed more significantly in group A than that in group B .The patients in group A had a significantly shorter duration of respiratory support than group B (P0.05），具有可比性。 　　1.2 方法 　　两组患者均应用无创面罩进行双水平气道正压通气（Bi-level positive airway pressure，BiPAP），呼吸机采用德国万曼公司生产的呼吸机BiPAP ST模式。吸气压调整范围为8～25 cm H2O，呼气压范围为4～10 cm H2O，氧流量2～10 L/min。根据动脉血气分析的结果对上述参数进行调整，保证患者的血氧饱和度（SaO2）≥90%，当患者病情趋于稳定，便逐渐脱离BiPAP呼吸机。如病情加重（包括窒息或喘憋加重，出现低血压，PaO2降至40 mm Hg以下，动脉血pH下降0.1）[5]，则立即给予气管插管机械通气治疗。A??患者在无创通气治疗的同时联合振动排痰，常州雅思医疗器械有限公司生产的体外振动排痰机，采用成人常用固定程序模式，直径90 mm的圆形海绵治疗头，由经过专门培训的护士操作。选择用叩击头在患者背部叩击，有外向内、自下而上进行振动排痰，根据患者情况选择频率15～30 Hz，每次15 min[6]，治疗上两组患者均给予抗感染、营养支持、对症治疗。 　　1.3 观察指标 　　监测两组患者无创通气前、无创通气1 h后的动脉血气指标；观察两组患者呼吸支持时间（包括无创