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目的对比无创正压通气(NPPV)对慢性阻塞性肺疾病(COPD)急性加重导致轻中度高碳酸血症与重度高碳酸血症的疗效。方法对比入选COPD急性加重导致轻中度高碳酸血症(PaCO2<80mmHg,1mmHg=0.133kPa)组患者和重度高碳酸血症(PaCO2>80mmHg)组患者NPPV2h后pH值和PaCO2的变化、24h后pH值恢复正常的人数、总的NPPV治疗时间和住院天数。结果轻中度高碳酸血症组44人,重度高碳酸血症组42人。轻中度高碳酸血症组和重度高碳酸血症组相对比,NPPV2h后pH值(分别为0.04±0.01和0.06±0.03,P=0.63)和PaCO2[分别为(14.3±7.4)mmHg和(18.1±11.2)mmHg,P=0.34]的改善程度相似。对比两组患者NPPV24h后pH值恢复正常比率(分别为65.9%和59.5%,P=0.65)、NPPV应用时间[分别为(103±8.1)h和(106±6.6)h,P=0.74]、住院天数[分别为(13±2.7)d和(15±4.1)d,P=0.53]及NPPV失败率(分别为13.6%和19.0%,P=0.56)也无差异。结论 NPPV治疗对COPD急性加重导致重度高碳酸血症的患者是有效的。
Objective To compare the efficacy of noninvasive positive pressure ventilation (NPPV) with acute exacerbation of chronic obstructive pulmonary disease (COPD) leading to mild to moderate hypercapnia and severe hypercapnia. Methods The changes of pH and PaCO2 in NPPV2h after mild exacerbation of COPD were compared with those of patients with mild or moderate hypercapnia (PaCO2 <80mmHg, 1mmHg = 0.133kPa) and severe hypercapnia (PaCO2> 80mmHg) The number of people returning to normal pH, the total NPPV treatment and hospital stay. Results In mild to moderate hypercapnia group 44 people, severe hypercapnia group 42 people. Compared with mild hypercapnia group and severe hypercapnia group, the pH values of NPPV2h (0.04 ± 0.01 and 0.06 ± 0.03 respectively, P = 0.63) and PaCO2 [(14.3 ± 7.4) mmHg and 18.1 ± 11.2 mmHg, P = 0.34]. The NPPV recovery time was compared between the two groups (65.9% and 59.5%, P = 0.65, respectively) after 24 hours of NPPV administration (103 ± 8.1 h and 106 ± 6.6 h, respectively, P = 0.74) Length of stay (13 ± 2.7) days and (15 ± 4.1) days, P = 0.53, and NPPV failure rates (13.6% and 19.0%, respectively, P = 0.56) were also indifferent. Conclusions NPPV is effective in patients with severe hypercapnia on the exacerbation of COPD.