【摘要】 目的探讨无创BiPAP通气中雾化吸入支气管扩张剂对慢性阻塞性肺疾病(COPD)并Ⅱ型呼吸衰竭患者的临床意义。方法选取在我院住院治疗的COPD伴Ⅱ型呼衰的患者45例,随机分成A、B、C 3组,每组各15例。3组在常规治疗基础上,A组每天上午及下午进行支气管扩张剂雾化吸入各1次;B组每日上午及下午进行BiPAP通气各2 h;C组综合A组和B组治疗,每天上午及下午进行BiPAP通气2 h,通气过程中雾化吸入支气管扩张剂各1次。观察患者治疗前后的呼吸频率、肺功能测定、血气分析、呼吸浅快指数、吸气时间/呼气时间的比值6、min行走距离、呼衰纠正时间。治疗3~8 d,比较通气前后各指标的差异。结果A组进行支气管扩张剂雾化吸入或B组进行BiPAP通气后,患者的呼吸频率有所减轻,FEV1有所上升,但差异尚未有统计学意义(P>0.05),而PCO2、PO2、f/Vt及6min行走距离明显改善(P<0.05或<0.01);C组综合A、B的治疗方法后,患者的各项指标均明显改善,且其改善程度比A、B两组更加明显,呼衰纠正时间明显缩短(P<0.05或<0.01)。A、B组之间则差异无统计学意义(P>0.05)。结论无创正压通气和雾化吸入支气管扩张剂均可独自有效纠正呼衰,两者同时使用存在协同作用,提示无创BiPAP通气联合雾化吸入支气管扩张剂在COPD并Ⅱ型呼吸衰竭患者有较好疗效,值得推广。更多还原

【Abstract】 Objective: To study the clinical value of the non-invasive bi-level positive airway pressure ventilation（BiPAP） combined with broncho-dilator aerosol inhalation（BAI） to the patients with chronic obstructive pulmonary diseases（COPD） accompanied with type Ⅱrespiratory failure（RFⅡ）.Methods Forty five cases of COPD with RFⅡwere selected. Three groups were randomly divided,each with 15 cases.Group A was treated with the BAI once in the morning and another in the afternoon;Group B with the Bi-PAP for two hours in the morning and another in the afternoon;and Group C with the Bi-PAP for two hours in the morning and another in the afternoon,and additional BAI one time.Seven variables were observed and compared before and after the treatment from 3 to 8 days,including respiratory frequency,pulmonary function test,blood gas analysis,tachypnea index,the ratio of expiratory duration and inspiratory duration,the six-minute walking distance,and the time of redressing respiratory failure.Results Group A and B had similar effects.After the treatment in group A and B patients,the PCO₂,PO₂,f/Vt and six-minute walking distance obviously improved,but the respiratory frequency,FEV1 and the time of redressing respiratory failure had no significant change.The patients in Group C obtained improvement in all index after the treatment（P<0.05 or <0.01） and the improved extents were more obviously than any that in Group A and B.Conclusion The non-invasive positive pressure ventilation and the bronchodilator aerosol inhalation treatment might work cooperatively and the combined application might have better effect to redress respiratory failure than any single one only,and be a preferable selection for the patients with chronic obstructive pulmonary diseases accompanied with Type Ⅱ respiratory failure.更多还原