【摘要】 目的观察BiPAP无创正压通气治疗COPD并发Ⅱ型呼吸衰竭的临床效果。方法32例COPD并发Ⅱ型呼吸衰竭患者在常规综合治疗的同时,选用BiPAP呼吸机行无创正压通气,选择合适口鼻面罩,设定参数S/T模式,预置呼吸频率12～16次/min,氧浓度30～35%左右,吸气压以8cmH2O开始,逐渐增加压力至20cmH2O,呼气压4cmH2O,每日上机二次,每次2～3h,3～7d为1疗程。在机械通气前、机械通气后2h、24h及通气结束时作血气分析,并观察临床效果。结果与治疗前相比,无创正压通气后2h、24h及治疗结束时,pH值改善(P<0.05),PaO2上升(P<0.01),PaCO2下降(P<0.01)。28例患者好转出院,2例患者病情加重,家属不同意气管插管而死亡,2例患者病情加重行气管插管机械通气治疗,其中1例死亡,1例成功撤机好转出院。结论BiPAP无创正压通气对COPD并发Ⅱ型呼吸衰竭患者疗效显著,避免了大部分气管插管或气管切开以及相应的并发症,减少病人的痛苦和医疗费用,使用方便,值得临床推广。更多还原

【Abstract】 Objective To evaluate the curative effect of BiPAP noninvasive positive pressure ventilation of COPD complicating with type Ⅱ respiratory failure.Methods 32 COPD patients with type Ⅱ respiratory failure accepted BiPAP noninvasive positive pressure ventilation besides of conventional therapy.Selecting the suitable mouth and nasal mask,setting the parameter S/T,the preset respiratory frequency was 12~16/min,the concentration of oxygen was 30~35%,the inspiratory pressure began at 8 mm H2O,and elevated to 20 mm H2O,the expiratory pressure was 4 mm H2O.Used ventilation twice a day,each was 2~3 h,and 3~7 days was one course of treatment.Clinical indexes and arterial blood gas parameters were observed before 2 h,4 h after treatment and treatment cease.Results 2 h,4 h after treatment and treatment cease,PH improved(P<0.05),PaO2 elevated(P<0.01),PaCO2 descended(P<0.01),28 patients was cured,2 patients exacerbated,and relations refused cannula and were dead.2 patients exacerbated and given cannula,1 died and 1 was cured.Conclusion The curative effect of BiPAP noninvasive positive pressure ventilation for COPD complicating with type II respiratory failure was prominent,avoid the most frequency of cannulas,trachea splitting and the complications,decreasing the pain and fee,convenient to use,and is worth to popularizeing.更多还原