无创机械通气治疗老年COPD合并呼吸衰竭的疗效分析

目的:观察无创机械通气治疗老年慢性阻塞性肺疾病(Chronic obstructive pulmon-ary disease,COPD)合并呼吸衰竭的临床效果及护理方法。方法:回顾分析我院2011年1月-2012年12月收治的COPD合并呼吸衰竭的老年患者122例,分为观察组与对照组,观察组采用BiPAP Vision呼吸机进行无创机械通气治疗,依据氧合调整EPAP,使脉搏血氧饱和度维持在90%以上,当病情好转,及时降低FiO2,降低呼吸条件。并在通气阶段配合心理护理,管道护理,气道湿化,预防感染等护理措施,使患者保持良好的心态,提高治疗依从性,对患者进及家属讲解该方法的优越性,协助患者取舒适体位。严密监护患者病情发展,加强与患者沟通,消除患者紧张、烦躁心理。定期观察患者意识、呼吸、HR、BP等变化。定时复查血气分析,保持充足的液体入量,及避免误解。对照组给予给予持续低流量吸氧治疗,1-3 L/min,并酌情给予呼吸兴奋剂静脉滴注。观察两组患者生命体征变化,并于治疗前后行动脉血气分析。结果:观察组患者治疗后PaO2、PaCO2较治疗前明显改善,治疗前后比较差异有统计学意义(P0.01);且上述指标较对照组改善更为明显,组间比较差异有统计学意义(P0.05)。结论:无创机械通气是治疗老年COPD合并呼吸衰竭的一种安全有效的方法。

Clinical Analysis of Noninvasive Mechanical Ventilation on the Treatmentof COPD Combined with Respiratory Failure*

Objective： To observe the clinical efficacy and nursing methods of noninvasive mechanical ventilation on the treatment of COPD complicated with respiratory failure. Methods： 122 elderly patients with COPD and respiratory failure who were admitted in our hospital from January 2011 to December 2012 were enrolled and divided into the observation group and the control group on the basis of different therapeutic regimens. The noninvasive mechanical ventilation treatment was used for the observational group with BiPAP Vision. Adjusted EPAP based on Oxygen saturation to maintain the pulse oximetry remained at more than 90%.To Lower FiO2 and respiratory conditions in time When condition improved. And aeration with psychological care, nursing pipeline, airway humidification, prevention of infection and other care measures, so that patients maintain a good attitude, improvetreatment compliance for patients and their families to explain the method intosuperiority, to help patients get comfortable position. Closely monitoring the pati ent＇s condition to develop, strengthen communication with patients, eliminating patienttension, irritability psychology. Regularly observed in patients with consciousness, breathing, HR, BP and other changes. Regular review of blood gas analysis, to maintain adequate fluid intake, and to avoid misunderstandings. The mental nursing, airway nursing, airway humidification and infection prevention were employed during the ventilation phase. The patients in the control group were given continuous low flow oxygen inhalation treatment, 1-3 L/min. And intravenous infusion of respiratory stimulants discretional. The change of the vital signs of the patients in the two groups was observed and the arterial blood gas analysis was performed before and after treatment. Results： The PaO2 and PaCO2 of patients in the observational group were obviously improved after the treatment than before with significant difference （P〈0.01）. Moreover, the improvement of the above indicators was more obvious when comparing with the control group with significant difference （P〈0.05）. Conclusions： The noninvasive mechanical ventilation is a safe and effective method to treat the the COPD complicated with respiratory failure for elderly patients.