无创正压通气治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭的疗效[摘要]目的探讨无创正压通气治疗慢性阻塞性肺疾病（COPD）急性加重期合并呼吸衰竭的临床疗效。方法将本院2010年11月～2011年11月收治入院的COPD患者65例随机分为治疗组（33例）和对照组（32例）。对照组给予临床常规治疗，治疗组在对照组治疗的基础上给予无创正压通气治疗，3次/d，2h/次，连续5d。观察两组治疗前后血气分析、呼吸、心率及临床预后。结果两组治疗5d后动脉血氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、呼吸、心率均较治疗前明显好转（P＜0.05）。治疗组治疗后呼吸、心率改善较对照组明显，差异有统计学意义（P＜0.05）；PaO2、PaCO2改善更明显，差异有统计学意义（P＜0.01）。治疗组气管插管率为9.09%（3/33），对照组为28.13%（9/32），两组比较差异有统计学意义（P＜0.05）。两组副作用比较差异无统计学意义（P＞0.05）。结论无创正压通气治疗COPD急性加重期合并呼吸衰竭能明显纠正患者血气交换障碍，降低气管插管率，值得临床推广应用。[关键词]无创正压通气；慢性阻塞性肺疾病；疗效；观察[]R56[文献标识码]A[]1674-4721（2012）06（a）-0059-02Observationofthecurativeeffectonnon-invasivepositivepressureventilationinthetreatmentofacuteexacerbationofchronicobstructivepulmonarydiseasecombinedwithrespiratoryfailureSUNLiyingYantaiHospitalofTraditionalChineseMedicineinShandongProvince,Yantai264000,China[Abstract]ObjectiveTodiscusstheclinicaleffectofnon-invasivepositivepressureventilationinthetreatmentofacuteexacerbationofchronicobstructivepulmonarydisease(COPD)combinedwithrespiratoryfailure.MethodsSixtyfivecasesofpatientswithacuteexacerbationofCOPDadmittedtoourhospitalfromNovember2010toNovember2011wererandomlydividedintotreatmentgroup(33cases)andcontrolgroup(32cases).Thecontrolgroupwasgivenclinicalconventionaltreatment.Onbasisofcontrolgroup,thetreatmentgroupwasgivennon-invasivepositivepressureventilation,3aday，2hoursonetime,for5days.Thebloodgasanalysis,respiration,heartrateandclinicaloutcomesbeforeandaftertreatmentbetweenthetwogroupswereobserved.ResultsAftertreatmentfor5days,thePaO2,PaCO2,respiration,heartrateinbothgroupswereimprovedcomparedwithbeforetreatment,therewerestatisticallysignificantdifferences(P＜0.05).Aftertreatment,therespirationandheartrateinthetreatmentgroupwerebetterthanthecontrolgroup,thedifferenceswerestatisticallysignificant(P＜0.05).WhilePaO2,PaCO2gotmuchbetterthanthecontrolgroup,thedifferenceswerehighlystatisticallysignificant(P＜0.01).Theintubationtuberateoftreatmentgroupwas9.09%(3/33),whichofcontrolgroupwas28.13%(9/32),thedifferencewasstatisticallysignificant(P＜0.05).Therewerenosignificantdifferencesofsideeffectsbetweenthetwogroups(P＞0.05).ConclusionThetreatmentofnon-invasivepositivepressureventilationinacuteexacerbationofCOPDcombinedwithrespiratoryfailurecancorrectthegasexchangesignificantly,decreasetheintubationtubeintotrachearate,whichisworthyofclinicalapplication.[Keywords]Non-invasivepositivepressureventilation;Chronicobstructivepulmonarydisease;Effect;Observation慢性阻塞性肺疾病（chronicobstructivepulmonarydiseases，COPD）急性加重期往往合并Ⅱ型呼吸衰竭，以往采用有创机械通气来治疗急性呼吸衰竭，虽然效果良好，但是由于其创伤大，需要气管插管或切开，给患者造成的痛苦大，且并发症多（如呼吸机相关性肺炎等），不适于临床大规模应用。随着有创通气带来的严重不良反应和机械通气技术的进步，无创正压通气（non-invasivepositivepressureventilation，NIPPV）具有创伤小、痛苦少、插管率低、并发症少、纠正气体交换异常的效果好、预后好等优点，越来越受到广大患者的欢迎和临床工的...