目的 觀察無創(chuàng)正壓通氣(NPPV)治療慢性阻塞性肺疾?。–OPD)呼吸衰竭昏迷患者的療效。方法 對入選的32例COPD Ⅱ型呼吸衰竭昏迷患者和42例COPD Ⅱ型呼吸衰竭非昏迷患者在常規(guī)治療的基礎(chǔ)上行雙水平無創(chuàng)正壓輔助通氣(BiPAP),動態(tài)觀察治療前后動脈血氣、Glasgow昏迷評分(GCS)、NPPV天數(shù)、有效率及不良反應(yīng)情況。結(jié)果 昏迷組32例患者中30例經(jīng)BiPAP通氣后好轉(zhuǎn)(2 h后意識轉(zhuǎn)清26例,3~8 h意識轉(zhuǎn)清3例,24 h后完全清醒1例),血氣分析指標(biāo)好轉(zhuǎn),潮氣量、每分通氣量增加,通氣(9±4)d恢復(fù)至穩(wěn)定期狀態(tài),與非昏迷組(7±3)d比較差異無統(tǒng)計學(xué)意義(P gt;0.05)。但昏迷組胃腸脹氣的發(fā)生率高,較非昏迷組明顯增加(80.5%比10.6%,P gt;0.05)。兩組間成功率沒有明顯差異(93.75%比97.62%,P gt;0.05)。結(jié)論 COPD Ⅱ型呼吸衰竭并發(fā)高碳酸血癥昏迷不是NPPV治療的絕對禁忌證。
引用本文: 李秀,王同,丁震,陳若靜,張春美,吳祖鳳,張素萍. 無創(chuàng)正壓通氣救治慢性阻塞性肺疾病呼吸衰竭高碳酸血癥昏迷的療效觀察. 中國呼吸與危重監(jiān)護雜志, 2007, 6(2): 114-118. doi: 復(fù)制
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- 1. Hill NS.Noninvasive positive pressure ventilation for respiratory failure caused by exacerbations of chronic obstructive pulmonary disease:a standard of care? Crit Care,2003,7:400-401.
- 2. Criner GJ,Brennan K,Travaline JM,et al.Efficacy and compliance with noninvasive positive pressure ventilation in patients with chronic respiratory failure.Chest,1999,116:667-675.
- 3. Celikel T,Sungur M,Ceyhan B,et al.Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure.Chest,1998,114:1636-1642.
- 4. 李秀,陳若靜,吳祖鳳,等.BiPAP治療COPDⅡ型呼吸衰竭的療效觀察.安徽醫(yī)學(xué),2006,27:169-171.
- 5. 李堅,張德厚,孫麗萍 等.無創(chuàng)正壓通氣救治慢性阻塞性肺疾病呼吸衰竭后期失敗的相關(guān)因素分析.中國呼吸與危重監(jiān)護雜志,2003,2:100-103.
- 6. Keenan P,Sinuff T,Cook DJ,et al.Which Patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure Ventilation? Ann Inter Med,2003,138:861-870.
- 7. 中華醫(yī)學(xué)會呼吸病學(xué)分會慢性阻塞性肺疾病學(xué)組.慢性阻塞性肺疾病診治指南.中華內(nèi)科雜志,2002,41:640-646.
- 8. 中華醫(yī)學(xué)會呼吸病學(xué)會臨床呼吸生理及ICU組.無創(chuàng)正壓通氣臨床應(yīng)用中的幾點建議.中華結(jié)核和呼吸雜志,2002,25:130-134.
- 9. 王華靜,張琴,李艷 等.呼吸機相關(guān)肺炎的病因及防治對策.中華醫(yī)院感染學(xué)雜志,2004,14:1232-1233.
- 10. Diaz GG,Alcaraz AC,Talavera JC,et al.Noninvasive positive-pressure ventilation to treat hypercapnic coma secondary to respiratory failure.Chest,2005,127:952-960.
- 11. 朱光發(fā),張蔚,宗華,等.無創(chuàng)正壓通氣治療慢性阻塞性肺疾病呼吸衰竭伴意識障礙的臨床研究.中國呼吸與危重監(jiān)護雜志,2006,5:332-336.
- 12. 朱蕾,鈕善福,李燕芹,等.經(jīng)面罩機械通氣治療慢性阻塞性肺病呼吸衰竭昏迷患者的療效評價.中國危重病急救醫(yī)學(xué),1997,9:28-31.
- 13. 王吉耀,主編.內(nèi)科學(xué).人民衛(wèi)生出版社,2005,47.
- 14. 朱蕾,鈕善福,主編.機械通氣.上??茖W(xué)技術(shù)出版社,2001,106.
- 15. 朱蕾,鈕善福,主編.機械通氣.上??茖W(xué)技術(shù)出版社,2001,302.
- 16. 朱蕾,鈕善福,主編.機械通氣.上??茖W(xué)技術(shù)出版社,2001,306.
- 17. 王保國,主編.實用呼吸機治療學(xué),人民衛(wèi)生出版社,1994,95-96.
- 18. 朱蕾,劉又寧,于潤江,主編.臨床肺功能.人民衛(wèi)生出版社,2004,62-63.
- 19. Esteban A,F(xiàn)rutos-Vivar F,F(xiàn)erguson ND,et al.Noninvasive positive-pressure ventilation for respiratory failure after extubation.N Engl J Med,2004,350:2452-2460.