无创呼吸机在有创通气治疗COPD合并Ⅱ型呼吸衰竭脱机中的应用临床观察(1)
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【摘要】 目的 探讨无创呼吸机在有创通气治疗COPD合并Ⅱ型呼吸衰竭脱机中的应用。方法 将36例患者分为治疗组(20例)和对照组(16例)，对照组在脱机过程中使用常规治疗。治疗组在常规治疗基础上给予序贯脱机治疗。 结果 两组脱机成功率、拔管后血气分析结果均有明显差异(P<0.01)。 结论 采用拨管后给予无创呼吸机通气治疗，可以提高有创通气治疗的脱机成功率。
【关键词】无创呼吸机；COPD；Ⅱ型呼吸衰竭；脱机
The clinical obseration of invasive Ventilation to treatment COPD complication with Type Ⅱ respiratory in spontaneously breathing without respirator by noninvasive respiratory machine
YU Tianfeng, HUANG Bin,ZHU Weiyi, et al.
Department of Respiratory, Shantou City Central Hospital, Shantou 515031, Guangdong Province, China
【Abstract】 Objective
To explore the application of invasive ventilation to treatment COPD complicated with TypeⅡrespiratory failure in spontaneously breathing without respirator by noninvasive respiratory machine. Methods 36 Patients with COPD complicated with TypeⅡ respiratory failure were divided randomly into treatment group (20 cases) and control group (16 cases). The control group(n=16) received conventional therapy additional spontaneously breathing without respirator,while the treatment group(n=20) received conventional therapy additional sequential spontaneously breathing without respirator.Results The success rate of spontaneously breathing without respirator and the resulte of blood gas analysis of trachea cannulas were pulled out showed a significant differences (P<0.01) between treatment group and the control group.Conclusion Noninvasive ventilation to treatment COPD complicated with TypeⅡrespiratory failure after extubation can be used to increase the success rate of spontaneously breathing without respirator.
【Key words】Noninvasive respiratory machine; COPD; Type Ⅱ respiratory failure; Spontaneously breathing without respirator
1 资料与方法
1.1 一般资料 38例患者男27例，女11例，年龄52~81岁，平均68.5岁。其中治疗组22例，对照组16例。两组年龄、性别、病情严重程度比较差异无统计学意义(P>0.05)，具有可比性。所有患者均诊断为慢性阻塞性肺病，慢性呼吸衰竭Ⅱ型，肺性脑病。均符合《COPD诊治指南(2007年修订版)》[1]诊断标准及Ⅱ型呼衰诊断标准[2]，病情急性加重的原因全部除外肺栓塞、气胸。均给予气管插管、有创呼吸机通气治疗2~5 d。治疗组除常规治疗外，并在气管拔管后加用无创呼吸机通气治疗。两组病例比较脱机成功率、拔管后血气分析结果。
1.2 治疗方法
1.2.1 所有患者均予控制性氧疗、依照病情选用合适抗生素、祛痰、雾化吸入支气管扩张剂及静脉平喘治疗、纠正酸碱平衡、营养支持等治疗。
1.2.2 NPPV治疗 治疗组22例患者均具备无创通气指征而没有绝对禁忌证 ......
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