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非呼吸系统病理因素对面罩正压机械通气治疗慢性阻塞性 肺疾病急性发作期患者临床疗效的影响

The effect of nonrespiratory pathogenic factors on clinical outcome of treatment by mask positive pressure mechanical ventilation for chronic obstructive pulmonary disease patients during acute stage

摘要:

目的:试图阐明非呼吸系统病理因素对面罩正压机械通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)急性发作期患者临床疗效的影响。方法:根据NIPPV最终治疗效果,将患者分为有效组与无效组,比较2组非呼吸系统病理因素的差异,分析无效组患者最终放弃NIPPV治疗措施的原因。[HTH结果:进入研究的58例COPD急性发作期患者,有效组与无效组患者呼吸系统的基本病理状态、基础治疗以及进入ICU时血气分析结果无明显差别。但是,经过仅1个小时的NIPPV治疗后,有效组患者的高碳酸血症及呼吸性酸中毒得到明显改善。NIPPV治疗前无效组患者血浆白蛋白浓度〔(32.5±7.2)g/L〕明显低于有效组〔(37.2±5.0)g/L〕。无效组中47.1%的患者是非直接的呼吸系统因素(循环状态恶化、烦躁和消化系统紊乱)导致最终放弃NIPPV治疗,而行气管插管后的机械通气治疗。结论:对于COPD急性发作期患者,在实施NIPPV治疗的同时,积极控制感染、纠正低蛋白血症及内环境紊乱,尤其是加强循环系统监护治疗,将有助于提高NIPPV治疗的成功率。

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abstracts:

To illustrate the effect of nonrespiratory pathogenic factors onclinical outcome of treatment by face[ CD2 mask positive pressure mechanical ventilation (NIPPV) for chronic obst ructive pulmonary disease (COPD) patients during acute stage.Methods:Patients were divided into effective and ineffective groups according to the final results of NIPPV treatment.Differences in nonrespiratory pathoge nic factors between effective and ineffective groups were compared,and the reaso ns with regard to termination of NIPPV treatment were analyzed in ineffective group.Results:There were no significant differences in basic pathological state of respiratory system,elementary treatment and blood gas analysis between the two groups in 58 COPD patients when admitted to ICU.After onehour NIPPV treatment,ho wever,hypercapnia and respiratory acidosis were apparently improved in effective group.The blood albumin in ineffective group was significantly lower than that of the effective group〔(32.5±7.2)g/L vs.(37.2±5.0)g/L〕.The reasons related to termination of NIPPV treatment showed that 47.1% patients underwent intubation as a result of nonrespiratory pathologic factors.Conclusions:For the COPD patients during acute stage,amelioration of low blood albumin and anxiety,and circulation support would be useful for the successful implementation of NIPPV treatment.

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