周秋玲　肖春莲　黄彩霞

【摘要】 目的 观察老年慢性阻塞性肺疾病(COPD)伴呼吸衰竭早期应用Bipap 呼吸机治疗的效果。方法 50例患者随机分为两组，每组25例。对照组仅行常规抗感染化痰解痉治疗；实验组行常规抗感染及化痰解痉等治疗外，加用Bipap呼吸机通气，根据患者的病情选择呼吸机参数，观察无创通气对患者血气的影响。结果 对照组25例中有9例因病情加重改用无创及有创通气；实验组中有3例因痰多，意识障碍而改用有创通气。与对照组相比，实验组血气结果提示PaCO₂，PaO₂，血氧饱和度均有明显改善。结论 早期应用无创通气可显著改善患者血气，疗效好。

【关键词】 慢性阻塞性肺疾病；老年人；呼吸衰竭；正压通气；护理

The monitoring and nursing of aged copd complicated with respiratory failure patients given by Noninvasive bilevel positive airway pressure ventilation

ZHOU Qiu-ling,XIAO Chun-lian,HUANG Cai-xia.The peoples hospital of Baoan,Shenzhen Guangdong 518101,China

【Abstract】 Objective To observe the treatment effect of Bipap to the patients with COPD complicated with respiratory failure at early stage.Methods 50 patients were randomly divided into control group and experimental group,each group 25 patients.The control group only received Conventional anti-infection phlegm spasmolysis therapies; the experimental group received this therapy too,and added Bipap Ventilator-ventilation.the Ventilators parameter is regulated according to patients condition.Then recode the blood gas analysis data.Results Among the 25 control group patients,9 patients were changed to noninvasive or invasive ventilation because of exacerbation;3 patients in experiment group were changed to invasive ventilation because of excessive phlegm,conscious disturbance.compared with the control group,the experimental groups blood gas analysis is better in pH、PaCO₂、PaO₂、and saturation of blood oxygen.Conclusion at the early stage,Bipap can gain a better blood gas with Noninvasive bi-level positive airway pressure ventilation.

【Key words】 COPD; Aged; Respiratory failure; Positive pressure ventilation; Nursing

慢性阻塞性肺疾病(COPD)是一种严重的慢性呼吸系统疾病，病死率高，在综合治疗的基础上，改善和增加通气以达到纠正机体缺氧和促进二氧化碳排出是治疗的关键。2006-2007年我们在COPD合并呼吸衰竭早期应用无创双水平正压通气(Bipap)呼吸机治疗，取得了良好的效果。

1 资料与方法

1．1 临床资料 对照组25例，男18例，女7例，年龄(61~90)岁，平均70岁；实验组25例，男16例，女9例，年龄(65~81)岁，平均72岁。均符合COPD伴呼吸衰竭的诊断标准^[1],临床表现为气促，呼吸频率大于30次/min，血气分析结果提示2型呼吸衰竭

1．2 方法 对照组行常规抗感染、祛痰、解痉及抗炎治疗；实验组在上述治疗基础上加用Bipap呼吸机通气，通气参数的选择是一般吸气压(IPAP)自6 cm H₂O（1 cm H₂O=0．098 kPa）开始，逐渐上调至（16~20）cm H₂O，呼气压(EPAP)自2 cm H₂O起始，逐渐上调至（6~8）cm H₂O。根据患者的病情及适应情况，每次通气2~6 h，1~2次/d，疗程7~10 d，记录并比较通气前后血气分析中pH，PaCO₂，PaO₂，血氧饱和度值。……