无创双水平正压与有创压力支持通气在慢性阻塞性肺疾病急性加重期中的应用研究(1)
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[摘要] 目的：探讨无创双水平正压通气在COPD急性加重期的临床应用价值，并与有创压力支持通气治疗进行比较研究。方法：将36例诊断为COPD急性加重期需要通气的患者随机分为观察组和对照组，每组各18例。两组患者均常规给予持续低流量吸氧、抗感染、支气管扩张剂、激素、氧疗、纠正酸碱失衡等对症治疗；观察组加用美国伟康 BiPAP AVAPS 双水平呼吸机，配置合适的鼻罩或面罩，选择S/T控制模式；对照组经口气管插管，应用GALILEO Gold伽利略呼吸机治疗。观察两组患者在通气过程中的呼吸、心率及血气分析结果变化。结果：治疗后观察组pH值(7.39±0.14)、PaO2[(8.9±1.3)kPa]、PaCO2[(6.7±0.8)kPa]三指标改善与对照组[(7.30±0.12)、(8.1±1.0)kPa、(7.3±0.9)kPa]比较，差异有统计学意义(t=2.071、2.069、2.114，均P<0.05)；治疗后观察组生命体征变化[RR(18±5)次/min、HR(87±6)次/min]与对照组[(22±6)次/min、(93±9)次/min]比较，差异有统计学意义(t=2.173、2.353，均P<0.05)。结论：无创双水平正压治疗COPD急性加重期有较好的治疗作用，明显提高PaO2水平，降低PaCO2水平，且比常规机械通气脱机方便、舒适，值得在临床推广应用。
[关键词] 无创双水平正压；机械通气；COPD；急性加重期
[中图分类号] R563[文献标识码]A [文章编号]1673-7210(2011)08(a)-054-03
Applied research on noninvasive bi-level positive pressure and invasive pressure support ventilation during acute exacerbation period of COPD
WU Liming, TAN Zhiwei, ZHOU Xunying, LIANG Yongxiang, LI Shuguang
Department of Respiratory Internal Medicine, the People's Hospital of Xinxing County, Guangdong Province, Xinxing527400, China
[Abstract] Objective: To explore the clinical application value of noninvasive bi-level positive pressure during acute exacerbation period of COPD and make comparison with invasive pressure support ventilation treatment. Methods: 36 patients who were diagnosed as acute exacerbation period of COPD and in need of ventilation were divided into observation group and control group with 18 patients respectively. Two groups of patients were all given symptomatic treatments such as regular continuous low flow oxygen uptake, infection resistant, bronchodilator, hormone, oxygen therapy and corrective acid-base unbalance; for the observation group, respironics BiPAP AVAPS bi-level breathing machine were given extra and proper nose masks or masks were equipped while S/T control mode were selected; the control group was adopted the intubation tube by mouth and GALILEO Gold breathing machine ......
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