【摘要】 目的:探讨慢性阻塞性肺疾病(COPD)Ⅱ型呼吸衰竭患者的机械通气治疗方式。方法:回顾分析过去4年我院ICU收治的60例COPD患者机械通气的治疗情况。结果:12例进行了经口鼻面罩无创正压机械通气(NIPPV),治疗后较治疗前平均2h PaCO2无显著性差异(P>0.05),PaO2显著升高(P<0.05);对治疗的耐受率为66.67%(8/12),死亡率为16.89%(2/12),存活者平均住ICU时间为5.2d。40例进行了经口气管插管有创通气,治疗后较治疗前平均2h PaCO2显著降低(P<0.01),PaO2显著升高(P<0.01);在适当镇静下对治疗的耐受率为100%(40/40),死亡率为17.50%(7/40),存活者平均住ICU时间为15.25d。8例进行了有创序贯无创机械通气,切换成无创通气后平均2h PaCO2及PaO2较切换前均有所上升,但无统计学意义(均P>0.05);对切换后无创通气治疗的耐受率为75%(6/8),死亡率25%(2/8),存活者平均住ICU时间为10.40d。结论:COPDⅡ型呼吸衰竭患者的三种机械通气治疗方式各有特点,应个体化选择机械通气治疗方式。更多还原

【Abstract】 Objective:To investigate the treating method of mechanical ventilation on patients with chronic obstructive pulmonary disease(COPD)Ⅱ respiratory failure.Methods:We retrospectively analyzed the treating status of mechanical ventilation on 60 patients with COPD Ⅱ respiratory failure in the past 4 years.Results:Twelve patients were treated by noninvasive positive pressure ventilation(NIPPV) using mouth-nasal mask,the pre and average post 2 hours PaCO2 showed no remarkable decrease(P>0.05),but PaO2 increased obviously(P<0.05);the tolerant ratio was 66.67%(8/12),mortality rate was 16.89%(2/12),average ICU stay time of survivals was 5.2days.Forty patients were treated with invasive mechanical ventilation through mouth intubation,the pre and post average 2 hours PaCO2 of treatment decreased obviously(P<0.01),PaO2 increased remarkably(P<0.01).The tolerant rate under the appropriate sedation was 100%(40/40),mortality rate was 17.50%(7/40),the average ICU stay time of survivals was 15.25 days.Eight patients were treated with sequential noninvasive following invasive mechanical ventilation,the pre and post average 2 hours PaCO2 and PaO2 of treatment after cycling showed mild increased,but no statistical meaning(P>0.05).The tolerant ratio was 75%(6/8)and mortality ratio was 25%(2/8),the average ICU stay time of survivals was 10.40 days.Conclusion:The three mechanical ventilatory treatments on the patients with COPD Ⅱ respiratory failure had different characteristics,so individually selecting the treatment method of mechanical ventilation should be emphasized.更多还原