海南医科大学学报

目的:观察无创正压通气对COPD急性加重期呼吸衰竭的治疗作用及护理要点。方法:对我市中心医院2009年1月～2010年1月间临床资料完整的COPD急性加重期呼吸衰竭患者76例进行分析,按其治疗方法分为治疗组及对照组,每组各38例,治疗组在内科常规用药的基础上加用无创正压通气治疗。对照组在常规用药治疗的基础上采用吸氧治疗。分别测定两组患者入院后4h、24h、72h、第5天、出院后第30天的血气分析;统计两组患者住院天数及3个月内再住院例数,并进行统计学处理。结果:治疗组治疗4h后pH即明显回升,24h内持续好转,并处于相对稳定状态,对照组pH变化不明显。治疗组通气治疗短时间内PaCO2显著下降,对照组下降幅度较小,治疗组pH值及PaCO2改善均优于对照组(P<0.05),但两组PaCO2均不能降到正常水平。PaO2治疗组改善较明显。(出院后1个月血气分析两组无明显的差异。治疗组住院天数缩短,再次住院例数明显减少。)结论:COPD合并呼吸衰竭应尽早应用无创正压通气治疗,并实施高效快捷的护理,能较快纠正呼吸衰竭、改善肺功能、减少肺损伤,降低复发率。

Objective:To observe the efficacy of non-invasive positive pressure ventilation(NIPPV) on acute exacerbation in COPD patients and its nursing measurements.Methods:Data of 76 patients with acute exacerbation of COPD complicated with respiratory failure that were admitted to the central hospital of our city from January 2009 to January 2010 were divided into treatment group and control group according to different treatments,with 38 cases in each.The treatment group received NIPPV in addition to routine internal medication while the control group adopted oxygen therapy based on routine treatment.The blood gas analysis of two groups were observed at 4 h,24 h,72 h,the fifth day of hospitalization,and the 30th day after discharge from hospital.Hospital stay and the cases of patients in two groups readmitted to the hospital within 3 months were recorded for statistics processing.Results:The pH value in treatment group rebounded remarkably after 4 h,and kept improving within 24 h,remaining relatively stable while pH varies in the control group was not remarkable.PaCO2 in the treatment group fell remarkably in a short period while PaCO2 drop in the control group was within a small range.The treatment group showed better outcomes than the control group in pH and PaCO2 varies showing significant difference(P<0.05).However,PaCO2 in both groups failed to drop to normal level.No difference was observed in blood gas analysis of two groups 1 month after discharge from hospital.The hospital stay of the treatment group was shorter and number of cases of readmission was less than the control group.Conclusions:COPD complicated with respiratory failure can be treated with NIPPV together with efficient nursing.Consequently,respiratory failure can be corrected and pulmonary function can be improved quickly,thus reducing damage to the lung and decrease its recurrence rate.