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目的分析慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)患者使用无创性正压通气(NIPPV)治疗难以纠正的原因所在。方法回顾我院4年来应用NIPPV治疗AECOPD243例患者的资料,其中男169例,女74例。依据治疗前后临床症状、体征和动脉血气分析,分为有效组(206例)和无效组(37例)。对两组患者治疗前一般情况、用机情况以及NIPPV无效者进一步治疗情况进行分析。结果两组比较患者的意识情况、第一秒用力呼气容积(FEV1)减退的严重程度及痰液黏稠、引流不畅有显著性差异(P﹤0.05)。两组患者呼吸机连接方式、是否存在面罩漏气及呼吸机参数调节亦有显著性差异(P﹤0.05)。NIPPV无效组通过更换鼻罩、调整呼吸机压力、延长无创通气时间及纠正低血压、电解质紊乱等,19例患者仍通过无创通气治疗而得到好转。结论NIPPV原则上可适用于治疗各种情况的COPD合并呼吸衰竭的患者,但排痰能力严重减弱、呼吸道分泌物潴留、意识障碍以及有严重精神症状的患者,应慎重选用无创通气治疗。同时在使用无创通气的过程中应根据动脉血气情况及时调整连接方式和通气参数。
Objective To analyze the causes of non-invasive positive pressure ventilation (NIPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods The data of 243 AECOPD patients treated with NIPPV in our hospital over the past 4 years were reviewed, including 169 males and 74 females. According to clinical symptoms, signs and arterial blood gas analysis before and after treatment, divided into effective group (206 cases) and ineffective group (37 cases). The two groups of patients before treatment, general situation, the use of machine conditions and NIPPV ineffective further treatment analysis. Results There was a significant difference (P <0.05) between the two groups in the awareness of patients, the severity of FEV1 decline, and the stickiness and poor drainage of sputum. There was also a significant difference (P <0.05) between the ventilator connection mode of the two groups of patients, the presence or absence of mask leakage and the adjustment of ventilator parameters. In the NIPPV ineffective group, 19 patients were still cured by noninvasive ventilation by changing the nasal mask, adjusting the pressure of the ventilator, prolonging the duration of noninvasive ventilation and correcting hypotension and electrolyte imbalance. Conclusion In principle, NIPPV can be applied to patients with COPD complicated by respiratory failure in various situations. However, noninvasive ventilation should be carefully selected in patients with severe sputum excretion, respiratory secretions retention, unconsciousness and severe psychiatric symptoms. At the same time in the use of non-invasive ventilation in the process of arterial blood gas should be based on the timely adjustment of connection and ventilation parameters.