Efficacy of Non-invasive Bi-level Positive Airway Pressure Ventilation in the Patients with Type Ⅱ Respiratory Failure due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease_West China Medical Journal

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Department of Respiratory Medicine, the Second Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an 710004, China;

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Keywords：

无创双水平气道正压通气; 慢性阻塞性肺疾病; 呼吸衰竭

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目的:评价经口鼻面罩双水平气道正压通气(BiPAP)治疗慢性阻塞性肺疾病急性加重期(AECOPD)并发Ⅱ型呼吸衰竭的临床疗效。〖HTH〗方法〖HTSS〗:对照组30例AECOPD并Ⅱ型呼吸衰竭患者给予吸氧、抗感染、化痰平喘等常规治疗,观察组38例AECOPD并Ⅱ型呼吸衰竭患者,在常规治疗的基础上同时进行BiPAP通气治疗。观察两组治疗前及治疗后4 h、24 h及72 h动脉血气变化,比较治疗前后呼吸频率、心率和白细胞计数以及血浆内皮素-1含量的变化,观察两组住院时间、气管插管率及病死率的变化。结果:观察组治疗后4 h、24 h及72 h动脉血气pH、PaO2、SaO2、PaO2/FiO2均明显高于对照组(P lt;0.05),PaCO2明显下降(P lt;0.05)。呼吸频率、心率和白细胞计数较对照组均下降(P lt;0.05)。观察组血浆内皮素-1含量恢复至正常水平快于对照组,观察组和对照组患者住院时间、气管插管率及病死率均有显著性差异(P lt;0.05)。〖HTH〗结论〖HTSS〗:BiPAP治疗慢性阻塞性肺疾病急性加重期并发Ⅱ型呼吸衰竭患者疗效确切,能减少住院时间、降低插管率和病死率。

Citation： DONG Xilin,LI Jiazhi,WANT Yajuan,et al. Efficacy of Non-invasive Bi-level Positive Airway Pressure Ventilation in the Patients with Type Ⅱ Respiratory Failure due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease. West China Medical Journal, 2009, 24(4): 931-934. doi: Copy

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2.	PLANT P K, OWEN J L, ELLIOT M W. Early use of non-invasive ventilation for acute exacerbation of chronic obstructive pulmonary disease ongeneral respiratory wards: a multicentre randomised controlled trail[J]. Lancet,2000,355(6):1931-1935..
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5.	PAUWELS R A, BUIST A S, CALVERLEY P M A, et al. NHLBI/WHO global initiative for chronic obstructive lung disease (GOLD) workshop summary. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease[J]. Am J Respir Crit Care Med,2001,163(5):1257-1276..
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7.	朱光发,周新,钮善福,等.应用无创面罩通气治疗拒绝插管的重度高碳酸血症呼吸衰竭患者[J].中华结核和呼吸杂志,2003,26(6):381-382..
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9.	DIAZ G G, ALCARAZ A C, TALAVERA J C, et al. Noninvasive positive pressure ventilation to treat hypercapnic coma secondary to respiratory failure[J]. Chest,2005,127(3):952-960.〖ZK)〗.
10.	KOLODZIEJ M A, JENSEN L, ROWE B, et al. Systematic review of noninvasive positive pressure ventilation in severe stable COPD[J]. Eur Respir J,2007,30(2):293-306..
11.	李秀,王同,丁震,等.无创正压通气救治慢性阻塞性肺疾病呼吸衰竭高碳酸血症昏迷的疗效观察[J].中国呼吸与危重监护杂志,2007,6(2):114-118..
12.	陈欲晓,徐思成.无创正压通气在慢性阻塞性肺疾病所致严重呼吸衰竭昏迷患者中的应用价值[J].国际呼吸杂志,2007,27(21):1601-1603..
13.	HAY D W, HENRY P J, GOLDIE R G. Endothelin and the respiratory system[J]. TIPS,1993,14:29-32..
14.	FUKURODA T, FUJIKAWA T, OZAKI S, et al. Clearance of circulating endothelin1 by ETB receptors in rats[J]. Biochem Biophy Res Commun,1994,199(3):1461-1465.
15.	石彦明,薛立福,吴志兴,等.慢性肺心病降钙素基因相关肽内皮素心钠素的表达及其临床意义[J].心肺血管病杂志,2002,21(2):90-93.
16.	石彦明,薛立福,吴志兴,等.慢性肺心病降钙素基因相关肽内皮素心钠素的表达及其临床意义[J].心肺血管病杂志,2002,21(2):90-93..

1. 曹志新,王辰.无创机械通气的应用范围及指征[J].中华结核和呼吸杂志,2002,25(3):136-137..
2. PLANT P K, OWEN J L, ELLIOT M W. Early use of non-invasive ventilation for acute exacerbation of chronic obstructive pulmonary disease ongeneral respiratory wards: a multicentre randomised controlled trail[J]. Lancet,2000,355(6):1931-1935..
3. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南[J].中华结核和呼吸杂志,2002,25(8):453-460..
4. 中华医学会呼吸病学分会临床呼吸生理及ICU学组.无创正压通气临床应用中的几点建议[J].中华结核和呼吸杂志,2002,25(2):130-134..
5. PAUWELS R A, BUIST A S, CALVERLEY P M A, et al. NHLBI/WHO global initiative for chronic obstructive lung disease (GOLD) workshop summary. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease[J]. Am J Respir Crit Care Med,2001,163(5):1257-1276..
6. MEHTA S, HILL N S. Nonivasive ventilation[J]. Am J Respir Crit Care Med,2001,163(2):540-577..
7. 朱光发,周新,钮善福,等.应用无创面罩通气治疗拒绝插管的重度高碳酸血症呼吸衰竭患者[J].中华结核和呼吸杂志,2003,26(6):381-382..
8. 朱蕾.无创机械通气治疗呼吸衰竭[J].中华医学杂志,2004,84(5):435-437..
9. DIAZ G G, ALCARAZ A C, TALAVERA J C, et al. Noninvasive positive pressure ventilation to treat hypercapnic coma secondary to respiratory failure[J]. Chest,2005,127(3):952-960.〖ZK)〗.
10. KOLODZIEJ M A, JENSEN L, ROWE B, et al. Systematic review of noninvasive positive pressure ventilation in severe stable COPD[J]. Eur Respir J,2007,30(2):293-306..
11. 李秀,王同,丁震,等.无创正压通气救治慢性阻塞性肺疾病呼吸衰竭高碳酸血症昏迷的疗效观察[J].中国呼吸与危重监护杂志,2007,6(2):114-118..
12. 陈欲晓,徐思成.无创正压通气在慢性阻塞性肺疾病所致严重呼吸衰竭昏迷患者中的应用价值[J].国际呼吸杂志,2007,27(21):1601-1603..
13. HAY D W, HENRY P J, GOLDIE R G. Endothelin and the respiratory system[J]. TIPS,1993,14:29-32..
14. FUKURODA T, FUJIKAWA T, OZAKI S, et al. Clearance of circulating endothelin1 by ETB receptors in rats[J]. Biochem Biophy Res Commun,1994,199(3):1461-1465.
15. 石彦明,薛立福,吴志兴,等.慢性肺心病降钙素基因相关肽内皮素心钠素的表达及其临床意义[J].心肺血管病杂志,2002,21(2):90-93.
16. 石彦明,薛立福,吴志兴,等.慢性肺心病降钙素基因相关肽内皮素心钠素的表达及其临床意义[J].心肺血管病杂志,2002,21(2):90-93..

West China Medical Journal

Efficacy of Non-invasive Bi-level Positive Airway Pressure Ventilation in the Patients with Type Ⅱ Respiratory Failure due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease

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