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目的探讨双水平正压通气(BiPAP)治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床疗效。方法将54例COPD合并Ⅱ型呼吸衰竭的住院患者随机分为2组:对照组(n=28)予以常规综合治疗,治疗组(n=26)在常规综合治疗的基础上加用BiPAP无创通气治疗。4、72h后对2组患者的血气分析、心率、呼吸频率进行比较。出院时统计患者住院时间、插管率及病死率。结果 2组患者治疗前皆有明显的CO2潴留、低氧血症、pH值下降,血气分析显示治疗前2组差异无统计学意义(P均>0.05)。治疗后治疗组血气分析指标(pH、PaO2、PaCO2)及呼吸频率、心率改善均较对照组明显,差异有统计学意义(P均<0.05)。治疗组住院时间为(13.0±1.9)d,对照组为(17.2±2.9)d,2组比较差异有统计学意义(P<0.05)。治疗组插管率为3.8%(1/26),死亡率为0;对照组插管率为21.4%(6/28),死亡率为10.7%(3/28),插管率及死亡率2组相比差异均无统计学意义(P均>0.05)。结论 Bi-PAP无创通气治疗COPD合并Ⅱ型呼吸衰竭患者,能有效改善患者血气分析指标,提高救治成功率,缩短住院时间。
Objective To investigate the clinical effect of bi-level positive pressure ventilation (BiPAP) on chronic obstructive pulmonary disease (COPD) with type Ⅱ respiratory failure. Methods Fifty-four inpatients with COPD and type Ⅱ respiratory failure were randomly divided into two groups: the control group (n = 28), and the treatment group (n = 26) on the basis of conventional comprehensive therapy plus BiPAP noninvasive ventilation treatment. Blood gas analysis, heart rate and respiratory rate were compared between the two groups after 4 and 72 hours. Discharge statistics hospitalization time, intubation rate and mortality. Results Before treatment, both groups had significant CO2 retention, hypoxemia and pH drop. Blood gas analysis showed that there was no significant difference between the two groups before treatment (P> 0.05). After treatment, the blood gas analysis indexes (pH, PaO2, PaCO2), respiration rate and heart rate in the treatment group were significantly higher than those in the control group (all P <0.05). The hospitalization duration was (13.0 ± 1.9) days in the treatment group and (17.2 ± 2.9) days in the control group, with significant difference between the two groups (P <0.05). The intubation rate was 3.8% (1/26) and the mortality rate was 0 in the treatment group. The intubation rate in the control group was 21.4% (6/28) and the mortality rate was 10.7% (3/28). The intubation rate and mortality rate There was no significant difference between the two groups (P> 0.05). Conclusion Bi-PAP noninvasive ventilation in patients with COPD and type Ⅱ respiratory failure can effectively improve the blood gas analysis indicators, improve the success rate of treatment and shorten the hospital stay.