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目的 :评价无创性面罩机械通气治疗慢性阻塞性肺病 (COPD)严重呼吸衰竭的疗效与应用价值。方法 :选择 3 3例符合插管指征的COPD合并严重呼吸衰竭行机械通气治疗患者 ,其中 2 1例应用面罩通气 ,其余 12例建立了人工气道 ,总结对比两组的疗效与结果。结果 :1 两组的通气效果接近 :通气治疗 1h后动脉血气pH值、二氧化碳分压 (PaCO2 )两组均已开始有明显改善 (P均 <0 0 0 5 ) ,其变化量 (△pH、△PaCO2 )两组间无明显差异 (P >0 0 5 ,P >0 1) ;2 4h后两组血气均继续改善 (P均 <0 0 0 1) ,△pH、△PaCO2 两组间也无明显差异 (P >0 1,P >0 0 5 )。 2 一周后病情基本变化与最终转归两组间无明显差异 (P >0 2 5 ,P >0 9) ,但面罩组 1周内脱机成功 7/ 2 1(占 3 3 3 % ) ,优于人工气道组 1/ 12 (占 8 3 % )。 3 面罩组呼吸机应用时间和RICU住院时间均较人工气道组短 ,不良反应与并发症少。结论 :经面罩机械通气不但具有应用迅速、操作简单、痛苦小、不良反应少等优点 ,而且疗效肯定 ,对COPD合并呼吸衰竭治疗可作为首选方式 ;而人工气道则为经典的和不可或缺的联接方式 ,应作为必要时的补充。
Objective: To evaluate the curative effect and application value of noninvasive mask mechanical ventilation in treating severe respiratory failure of chronic obstructive pulmonary disease (COPD). Methods: Thirty-three patients with COPD complicated with severe respiratory failure undergoing mechanical ventilation were enrolled. Among them, 21 patients were treated with mask ventilation and the other 12 patients were established artificial airway. The curative effect and result of the two groups were compared. Ventilation effects were similar between the two groups. After 1 hour of ventilation, arterial blood gas pH value and partial pressure of carbon dioxide (PaCO2) started to improve significantly (P <0 05) △ PaCO2) had no significant difference between the two groups (P> 0.05, P> 0 1). After 24 hours, the blood gases in both groups continued to improve (P <0 01), △ pH and △ PaCO2 No significant difference (P> 0 1, P> 0 0 5). After one week, there was no significant difference between the two groups (P> 0 2 5, P> 0 9). However, in the mask group, the success rate was 7/2 2 (33.3%) in one week, Better than artificial airway group 1/12 (83%). 3 mask group ventilator application time and hospital stay RICU were shorter than the artificial airway, adverse reactions and complications less. Conclusion: Mechanical ventilation through the mask not only has the advantages of rapid application, simple operation, little pain and few adverse reactions, but also has the positive curative effect, which is the first choice for the treatment of COPD with respiratory failure. The artificial airway is the classic and indispensable The connection should be added as necessary.