无创呼吸机在慢性阻塞性肺疾病急性加重期应用的疗效评价

摘要目的：观察无创呼吸机对不伴有呼吸衰竭的慢性阻塞性肺疾病急性加重期（AECOPD）患者症状、体征、血气分析和肺功能的影响。方法：80例AECOPD患者随机分为对照组和试验组，对照组给予常规治疗，如常规抗感染、化痰、平喘等治疗。试验组在常规治疗的基础上给予无创呼吸机正压通气（NIPPV）治疗。评价两组患者治疗前和治疗一周后临床症状体征、血气分析和肺功能的变化。结果：两组患者治疗后临床症状及体征评分较治疗前均呈下降趋势（P〈0．05），但试验组下降更为明显（P〈0．05），并且试验组症状改善时间明显缩短（P〈0．05）；治疗后两组的pH，PO2和SaO2均较治疗前升高，PC02较治疗前下降（P〈0．05），和对照组相比，治疗后试验组的PO：和PC02改善更明显（P〈0．05），而pH和Sa02无显著差异（P〉0．05）；治疗后两组的FEV1，FVC，FEV1实测值／预计值和FEVI％均较治疗前升高（P〈0．05），试验组升高更明显（P〈0．05）。结论：对不伴有呼吸衰竭的AECOPD患者早期应用NIPPV治疗能有效改善临床症状和体征，缩短症状改善时间，改善通气，缓解呼吸肌疲劳，预防呼吸衰竭的发生。

The Effects of Non-Invasive Ventilator in Treatment with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective： To observe the effects of non-invasive ventilator on the symptoms, signs, blood gas analysis and pulmonary function indexes of patients with acute exacerbation of chronic obstructive disease （AECOPD） and without respiratory failure. Methods： 80 patients with AECOPD were divided into two groups randomly： control group and treatment group. Common therapy such as anti-infective, phlegm, asthma treatment were given to patients in control group, while NIPPV added to common therapy were given to patients in treatment group. Evaluated the clinical symptoms, signs, blood gas analysis and pulmonary fimction indexes of patients in both groups before and after 1 week treatment. Results： After the treatment, clinical symptoms and signs scores in both groups showed a downward tread （P〈0.05）, while the treatment group decreased more Significantly （P〈0.05）. And the time of symptoms improved significantly in treatment group was shorter than in control group （P〈0.05）. After treatment, pH, PO2 and SaO2 in both groups increased while PCO2 decreased（P〈0.05）. PO2 and PCOz in treatment group improved more obvious（P〈0.05）, while pH and SaO2had no significant differences （P〉0.05）. After treatment, FEV1, FVC, FEV1 actual/estimated and FEVI% all increased （P〈0.05）, and more significant in treatment group （P〈0.05）. Conclusion： Early use of NIPPV added to common therapy can effectively improve the clinical symptoms and signs, and shorten the time when symptoms improved significantly, and improve ventilation and relieve respiratory muscles fatigue, and prevent the occurrence of respiratory failure of patients with AECOPD and without respiratory failure.