目的 觀察無(wú)創(chuàng)正壓通氣(NPPV)治療慢性阻塞性肺疾?。–OPD)呼吸衰竭昏迷患者的療效。方法 對(duì)入選的32例COPD Ⅱ型呼吸衰竭昏迷患者和42例COPD Ⅱ型呼吸衰竭非昏迷患者在常規(guī)治療的基礎(chǔ)上行雙水平無(wú)創(chuàng)正壓輔助通氣(BiPAP),動(dòng)態(tài)觀察治療前后動(dòng)脈血?dú)?、Glasgow昏迷評(píng)分(GCS)、NPPV天數(shù)、有效率及不良反應(yīng)情況。結(jié)果 昏迷組32例患者中30例經(jīng)BiPAP通氣后好轉(zhuǎn)(2 h后意識(shí)轉(zhuǎn)清26例,3~8 h意識(shí)轉(zhuǎn)清3例,24 h后完全清醒1例),血?dú)夥治鲋笜?biāo)好轉(zhuǎn),潮氣量、每分通氣量增加,通氣(9±4)d恢復(fù)至穩(wěn)定期狀態(tài),與非昏迷組(7±3)d比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。但昏迷組胃腸脹氣的發(fā)生率高,較非昏迷組明顯增加(80.5%比10.6%,P gt;0.05)。兩組間成功率沒(méi)有明顯差異(93.75%比97.62%,P gt;0.05)。結(jié)論 COPD Ⅱ型呼吸衰竭并發(fā)高碳酸血癥昏迷不是NPPV治療的絕對(duì)禁忌證。
引用本文: 李秀,王同,丁震,陳若靜,張春美,吳祖鳳,張素萍. 無(wú)創(chuàng)正壓通氣救治慢性阻塞性肺疾病呼吸衰竭高碳酸血癥昏迷的療效觀察. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2007, 6(2): 114-118. doi: 復(fù)制
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- 2. Criner GJ,Brennan K,Travaline JM,et al.Efficacy and compliance with noninvasive positive pressure ventilation in patients with chronic respiratory failure.Chest,1999,116:667-675.
- 3. Celikel T,Sungur M,Ceyhan B,et al.Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure.Chest,1998,114:1636-1642.
- 4. 李秀,陳若靜,吳祖鳳,等.BiPAP治療COPDⅡ型呼吸衰竭的療效觀察.安徽醫(yī)學(xué),2006,27:169-171.
- 5. 李堅(jiān),張德厚,孫麗萍 等.無(wú)創(chuàng)正壓通氣救治慢性阻塞性肺疾病呼吸衰竭后期失敗的相關(guān)因素分析.中國(guó)呼吸與危重監(jiān)護(hù)雜志,2003,2:100-103.
- 6. Keenan P,Sinuff T,Cook DJ,et al.Which Patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure Ventilation? Ann Inter Med,2003,138:861-870.
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- 8. 中華醫(yī)學(xué)會(huì)呼吸病學(xué)會(huì)臨床呼吸生理及ICU組.無(wú)創(chuàng)正壓通氣臨床應(yīng)用中的幾點(diǎn)建議.中華結(jié)核和呼吸雜志,2002,25:130-134.
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