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目的:探讨高碳酸性呼吸衰竭患者(慢性阻塞性肺病,肥胖低通气综合征和支气管扩张)使用无创性机械通气的治疗价值。方法:116例慢性阻塞性肺病,19例肥胖低通气综合征和46例支气管扩张患者,因慢性高碳酸性呼吸衰竭而住院。第1次住院时未使用无创性机械通气,而在第2次住院时予以无创性机械通气。观察患者的肺功能,动脉血气和住院天数的变化。结果:慢性阻塞性肺病、肥胖低通气综合征和支气管扩张患者在使用无创性机械通气的过程中:①大多患者能表现很好的依从性,占91％。②动脉血气有所改善。PaCO2在慢性阻塞性肺病患者由62±10mmHg降至53±6 mmHg,(P<0．01);在肥胖低通气综合征患者由52±10mmHg降至42±7 mmHg,(P<0．001);在支气管扩张患者由56 ±6mmHg降至44±10mmHg,(P<0．005)。同时PaO2也有上升,分别由:(61±13)mmHg、(60±12)mmHg、(58 ±11)mmHg升到(71±15)mmHg、(71±11)mmHg和(75±18)mmHg,(P均<0．001)。③与未用无创性机械通气的住院时间相比,住院天数有减少(P<0．05)。结论:无创机械通气在慢性阻塞性肺病、肥胖低通气综合征和支气管扩张的治疗中依从性好、动脉血气有改善和住院天数缩短。
Objective: To investigate the therapeutic value of non-invasive mechanical ventilation in patients with hypercapnic respiratory failure (chronic obstructive pulmonary disease, obesity-hypoventilation syndrome and bronchiectasis). METHODS: One hundred and sixty-six patients with chronic obstructive pulmonary disease, 19 patients with obesity-hypoventilation syndrome and 46 patients with bronchiectasis were hospitalized for chronic hypercapnic respiratory failure. The first hospitalization did not use noninvasive mechanical ventilation but noninvasive mechanical ventilation on the second hospitalization. Observe the patient’s lung function, arterial blood gas and hospital days changes. Results: In patients with chronic obstructive pulmonary disease, obesity, hypoventilation syndrome and bronchiectasis, noninvasive mechanical ventilation was used: ① Most patients showed good compliance, accounting for 91%. ② arterial blood gas has been improved. PaCO2 decreased from 62 ± 10 mmHg to 53 ± 6 mmHg in patients with COPD (P <0.01), from 52 ± 10 mmHg to 42 ± 7 mmHg in patients with obesity-hypoventilation syndrome (P <0.001) ); From 56 ± 6 mmHg to 44 ± 10 mmHg in patients with bronchiectasis (P <0.005). PaO2 also increased from 61 ± 13 mmHg to 60 ± 12 mmHg and from 58 ± 11 mmHg to 71 ± 15 mmHg, 71 ± 11 mmHg, and 75 ± 18 mmHg, respectively , (P <0.001). ③Compared with hospital stay without noninvasive mechanical ventilation, hospital stay decreased (P <0.05). CONCLUSIONS: Noninvasive mechanical ventilation has good adherence to arterial blood gas and shortened hospital stay in chronic obstructive pulmonary disease, obesity, hypoventilation syndrome and bronchiectasis.