第18卷第23期中国现代医学杂志Vol.18No.23 2008年12月China Journal of Modern Medicine Dec.2008

文章编号：1005-8982（2008）23-3529-04

早期使用无创机械通气治疗慢性阻塞性肺瓣

疾病急性加重期的随机对照研究

许德凤，杨政，黄佳茹，戴文，丁薇，牛晓敏，瞿潮英，张礼礼，徐正芸

（上海市浦东新区公利医院呼吸科，上海200135）

摘要：目的观察早期使用NIPPV对AECOPD的血气分析,氧合指数的变化、气管插管上有创呼吸机比率及住院病死率等的影响。方法84例入住呼吸科的AECOPD患者[pH<7.35，动脉血二氧化碳分压（PaCO2）

大于50mmHg（1mmHg=0.133kPa）]。入选病例随机分常规治疗+NIPPV治疗组（A组，n＝44例）和常规治

疗组（B组，n＝40例）观察两组患者治疗前后0、2、24和72h及出院时动脉血气分析、呼吸频率（R R）、心率

（HR）的变化及氧合指数的变化，比较两组气管插管上有创呼吸机比率及住院病死率、平均住院日的改变。结

果NIPPV组PaO2、PaCO2、R R、HR、氧合指数治疗前后均有显著改善，pH值治疗前后比较有下降趋势；常规

治疗组PaCO2、氧合指数改变各组间的比较，差异无显著性；平均住院日NIPPV组显著低于常规治疗组（P=0.

004），而气管插管上呼吸机比率有降低趋势。结论AECOPD患者在常规治疗的基础上，早期应用NIPPV可

明显改善气体交换，缓解呼吸肌疲劳，减少住院天数。

关键词：呼吸衰竭；慢性阻塞性肺疾病；无创正压通气

中图分类号：R563.8文献标识码：B

Randomised controlled trial of early use of noninvasive

positive pressure ventilation for patients with acute

exacerbations of chronic obstructive disease

XU De-feng,YANG Zheng,HUANG Jia-ru,DAI Wen,DING Wei,

NIU Xiao-min,QU Chao-ying,ZHANG Li-li,XU Zheng-yun

(Department of Respiratory Shanghai Pudong New Area gongli Hospital,

Shanghai,210135,P.R.China)

Abstract:【Objective】To evaluate the effect of the early use of noninvasive positive pressure ventilation(NIP－PV)on gas exchange,rate of endotracheal intubation,oxygenate index and in-hospital mortality in patients with a－

cute exacerbation of chronic obstructive pulmonary disease(AECOPD).【Methods】84patients of AECOPD with

respiratory failure(pH<7.35,PaCO2>50mmHg,1mmHg=0.133kPa).The se cases were randomly assigned to stan－

dard medical treatment(group A,n=44)or early administration of NIPPV plus standard medical treatment(group B,

n=40).Blood gas results,respiratory rate and heart rate at different time points were compared,which were before

the use of NIPPV,2hours after initiation,day1,day3,and before discharge.The two different groups were com－

pared rate of endotracheal intubation,oxygenate index and in-hospital mortality.【Results】Indicators of arterial

blood gas were improved significantly after application of NIPPV,while PaO2increased significantly(P<0.05),and

PaCO2decreased meaningfully(P<0.01).【Conclusions】The early use of NIPPV improve arterial blood gas and

respiratory pattern,decreases the days of inpatient stay in hospital.NIPPV is indicative for alleviating respiratory

muscle fatigue and preventing respiratory failure from exacerbation.

Key words:respiratory failure;chronic obstructive pulmonary disease;noninvasive positive pressure ventilation 收稿日期：2008-05-14