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：

無創雙水平氣道正壓通氣; 慢性阻塞性肺疾病; 呼吸衰竭

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目的:評價經口鼻面罩雙水平氣道正壓通氣(BiPAP)治療慢性阻塞性肺疾病急性加重期(AECOPD)并發Ⅱ型呼吸衰竭的臨床療效。〖HTH〗方法〖HTSS〗:對照組30例AECOPD并Ⅱ型呼吸衰竭患者給予吸氧、抗感染、化痰平喘等常規治療,觀察組38例AECOPD并Ⅱ型呼吸衰竭患者,在常規治療的基礎上同時進行BiPAP通氣治療。觀察兩組治療前及治療后4 h、24 h及72 h動脈血氣變化,比較治療前后呼吸頻率、心率和白細胞計數以及血漿內皮素-1含量的變化,觀察兩組住院時間、氣管插管率及病死率的變化。結果:觀察組治療后4 h、24 h及72 h動脈血氣pH、PaO2、SaO2、PaO2/FiO2均明顯高于對照組(P lt;0.05),PaCO2明顯下降(P lt;0.05)。呼吸頻率、心率和白細胞計數較對照組均下降(P lt;0.05)。觀察組血漿內皮素-1含量恢復至正常水平快于對照組,觀察組和對照組患者住院時間、氣管插管率及病死率均有顯著性差異(P lt;0.05)。〖HTH〗結論〖HTSS〗:BiPAP治療慢性阻塞性肺疾病急性加重期并發Ⅱ型呼吸衰竭患者療效確切,能減少住院時間、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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6.	MEHTA S, HILL N S. Nonivasive ventilation[J]. Am J Respir Crit Care Med,2001,163(2):540-577..
7.	朱光發,周新,鈕善福,等.應用無創面罩通氣治療拒絕插管的重度高碳酸血癥呼吸衰竭患者[J].中華結核和呼吸雜志,2003,26(6):381-382..
8.	朱蕾.無創機械通氣治療呼吸衰竭[J].中華醫學雜志,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.無創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[J].中國呼吸與危重監護雜志,2007,6(2):114-118..
12.	陳欲曉,徐思成.無創正壓通氣在慢性阻塞性肺疾病所致嚴重呼吸衰竭昏迷患者中的應用價值[J].國際呼吸雜志,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.	石彥明,薛立福,吳志興,等.慢性肺心病降鈣素基因相關肽內皮素心鈉素的表達及其臨床意義[J].心肺血管病雜志,2002,21(2):90-93.
16.	石彥明,薛立福,吳志興,等.慢性肺心病降鈣素基因相關肽內皮素心鈉素的表達及其臨床意義[J].心肺血管病雜志,2002,21(2):90-93..

1. 曹志新,王辰.無創機械通氣的應用范圍及指征[J].中華結核和呼吸雜志,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. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組.慢性阻塞性肺疾病診治指南[J].中華結核和呼吸雜志,2002,25(8):453-460..
4. 中華醫學會呼吸病學分會臨床呼吸生理及ICU學組.無創正壓通氣臨床應用中的幾點建議[J].中華結核和呼吸雜志,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. 朱光發,周新,鈕善福,等.應用無創面罩通氣治療拒絕插管的重度高碳酸血癥呼吸衰竭患者[J].中華結核和呼吸雜志,2003,26(6):381-382..
8. 朱蕾.無創機械通氣治療呼吸衰竭[J].中華醫學雜志,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.無創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[J].中國呼吸與危重監護雜志,2007,6(2):114-118..
12. 陳欲曉,徐思成.無創正壓通氣在慢性阻塞性肺疾病所致嚴重呼吸衰竭昏迷患者中的應用價值[J].國際呼吸雜志,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. 石彥明,薛立福,吳志興,等.慢性肺心病降鈣素基因相關肽內皮素心鈉素的表達及其臨床意義[J].心肺血管病雜志,2002,21(2):90-93.
16. 石彥明,薛立福,吳志興,等.慢性肺心病降鈣素基因相關肽內皮素心鈉素的表達及其臨床意義[J].心肺血管病雜志,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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