医学毕业论文--BiPAP无创呼吸机治疗肺性脑病临床观察.doc

BiPAP无创呼吸机治疗肺性脑病临床观察 作者：邵传利，顾雪峰，陆斌，张智娟 【摘要】 目的 探讨肺性脑病患者使用BiPAP呼吸机无创正压通气的疗效。方法 对14例肺性脑病患者使用BiPAP呼吸机进行治疗，并通过自身对照，观察治疗前后血气分析结果的pH值、PCO2及PO2的变化以及神志的变化，判断疗效。结果 14例患者中，13例经给予BiPAP呼吸机治疗后动脉血气指标和症状较治疗前全部得到改善，pH值和PO2较治疗前明显升高，PCO2较治疗前明显下降，且差异有显著性意义(Plt;0.05和0.01)，1例患者因多脏器功能衰竭死亡。结论 BiPAP呼吸机无创正压通气可以明显改善肺性脑病患者的症状和动脉血气的pH值、PCO2及PO2，对COPD肺性脑病患者是一种安全、有效的抢救和治疗方法，值得临床广泛应用。 【关键词】 肺疾病,慢性阻塞性;肺性脑病; BiPAP呼吸机 　　【Abstract】 Objective To evaluate the clinical effect of bilevel positive airway pressure (BiPAP) ventilator’s noninvasive positive pressure ventilation in patients with pulmonary encephalopathy.Methods 14 cases with pulmonary encephalopathy were treated with BiPAP ventilator, and through self-contrast, their PH value of blood gas analysis, PCO2 and PO2 changes and changes of mind were observed before and after treatment so as to judge efficacy.Results Of the 14 patients, 13 had their arterial blood gas and symptoms improved after being treated with BiPAP ventilator. Their PH value and PO2 significantly were higher than before treatment, but PCO2 decreased compared with before treatment, and the differences were significant (Plt;0.05 and 0.01). One patient died due to multiple organ failure.Conclusion Noninvasive positive pressure ventilation via BiPAP ventilator can improve the symptoms of pulmonary encephalopathy and PH value, PCO2 and PO2 of arterial blood gas. For pulmonary encephalopathy patients with COPD, it is a safe and effective rescue and treatment. So it is worthy of being widely applied. 　　【Key word】 Chronic obstructive pulmonary disease;Pulmonary encephalopathy; Bilevel positive airway pressure (BiPAP) breathing apparatus; 　　慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)是呼吸系统的常见病和多发病，肺性脑病(pulmonary encephalopathy，PE)是慢性阻塞性肺疾病急性加重期的严重并发症，是由于呼吸衰竭所致缺氧、二氧化碳潴留引起的精神、神经系统症状的一种综合征，是COPD合并呼吸衰竭的危重表现，也是患者死亡的重要原因，病死率高达50%以上[1]。近年来，BiPAP无创呼吸机在COPD的治疗中得到了广泛的应用，但多用于清醒患者。我科应用BiPAP无创呼吸机对14例肺性脑病患者进行治疗，成功救治了13例患者，取得了较好的效果，现报告如下。 　　1 资料与方法 　　1.1 资料 2009年7月～2010年4月我院呼吸科收治的14例肺性脑病患者