赵淼英++沈国娣

[摘要] 目的 探讨强化优质护理对无创正压通气治疗老年AECOPD合并Ⅱ型呼吸衰竭的影响。 方法 选择125例老年AECOPD合并Ⅱ型呼吸衰竭患者进行无创正压通气治疗，随机分为干预组63例和对照组62例。干预组给予强化优质护理，对照组给予常规护理，观察无创正压通气对患者呼吸频率、心率、血氧饱和度及动脉血气指标改变，对比两组治疗效果、机械通气时间、住院时间及不良反应、并发症。 结果 通气前后动脉血气分析指标PaO2、PaCO2、pH比较，差异均有统计学意义（P<0.05），通气2、12、24、72 h与通气前比较，差异均有统计学意义（P<0.05），各时间点之间比较，差异均有统计学意义（P<0.05）。通气前后呼吸频率、心率、血氧饱和度比较，差异均有统计学意义（P<0.05），通气2、12、24、72 h与通气前比较，差异均有统计学意义（P<0.05），呼吸频率通气12、24、72 h基本稳定，均较通气2 h明显降低，心率通气24 h、72 h基本稳定，均较通气12 h明显降低，血氧饱和度通气12、24、72 h均达到90%左右，均较通气2 h明显升高（P<0.05）。两组治疗有效率比较，差异无统计学意义（P>0.05），但干预组机械通气时间和住院时间均明显少于对照组（P<0.05）。干预组面罩漏气、压伤、误吸/呛咳、胃肠胀气、感染及气切发生率均显著低于对照组（P<0.05）。 结论 无创正压通气可有效改善老年AECOPD合并Ⅱ型呼吸衰竭患者呼吸、循环、血气分析指标，强化优质护理有助于改善患者机械通气效率，降低不良反应及并发症发生率。

[关键词] 慢性阻塞性肺疾病急性加重；呼吸衰竭；无创正压通气；护理

[中图分类号] R563.9 [文献标识码] B [文章编号] 1673-9701（2015）09-0147-04

Noninvasive positive pressure ventilation treatment of elderly AECOPD with type Ⅱ respiratory failure and nursing

ZHAO Miaoying1 SHEN Guodi2

1.Infusion Section，the Central Hospital of Yiwu City in Zhejiang Province，Yiwu 322000，China；2.EICU，the Central Hospital of Huzhou City in Zhejiang Province，Huzhou 313000，China

[Abstract] Objective To strengthen the quality nursing on effect of noninvasive positive pressure ventilation in the treatment of aged AECOPD combined with respiratory failure type. Methods A total of 125 cases of elderly patients with type Ⅱ respiratory failure AECOPD patients with noninvasive positive pressure ventilation treatment， 63 cases were randomly divided into intervention group and control group 62 cases， strengthen the quality of care given to the intervention group， the control group received routine care， observation of non-invasive positive pressure ventilation in patients with respiratory rate， heart rate， oxygen saturation and arterial blood gas analysis indicators change， compared two groups of treatment， duration of mechanical ventilation， length of stay and adverse reactions and complications. Results Arterial blood gas analysis before and after ventilation PaO2， PaCO2， PH， the difference were statistically significant（P<0.05）， ventilation 2 h， 12 h， 24 h， 72 h compared with before ventilation， the differences were statistically significant （P<0.05）， comparison between the various time points， the differences were statistically significant （P<0.05）. Respiratory rate， heart rate， oxygen saturation before and after aeration， the differences were statistically significant （P<0.05）， ventilation 2 h， 12 h， 24 h， 72 h compared with before ventilation， the differences were statistically significant（P<0.05）， respiratory frequency ventilation 12 h， 24 h， 72 h 2 h basically stable compared with ventilation significantly reduced，heart rate ventilation 24 h， 72 h 12 h basically stable compared with ventilation significantly decreased oxygen saturation ventilation 12 h， 24 h， 72 h were up about 90 percent compared with ventilation 2 h significantly increased （P<0.05）. There were relatively efficient treatment in both groups， the difference were not statistically significant （P>0.05）， but the intervention group duration of mechanical ventilation and length of stay were significantly less than the control group （P<0.05）. Intervention group mask leaks， bruised， aspiration/choking， flatulence， infection and incidence of tracheostomy were significantly lower than the control group （P<0.05）. Conclusion Noninvasive positive pressure ventilation can effectively improve the Elderly AECOPD patients with type Ⅱ respiratory failure respiration， circulation， blood gas analysis， and strengthen the quality of care and help to improve the efficiency of mechanical ventilation in patients with reduced incidence of adverse reactions and complications.

[Key words] Chronic obstructive pulmonary disease exacerbations； Respiratory failure； Noninvasive positive pressure ventilation； Care

慢性阻塞性肺疾病急性加重（AECOPD）是COPD的重症状态，常可引起呼吸衰竭甚至多器官功能衰竭导致严重后果甚至死亡[1]。呼吸机通气是重要的治疗手段，有创机械通气可以有效改善患者症状，但侵入性操作增加患者创伤及感染风险，且撤机较为困难，具有一定局限性，无创正压通气通过面罩、鼻罩等方式进行辅助通气，避免对患者造成有创损伤，普遍应用于临床[2，3]，但治疗效果仍需要高质量护理辅助，提高机械通气效果，减轻患者不适反应，降低并发症发生率。本研究对无创正压通气治疗老年AECOPD治疗效果进行分析并探讨提高护理质量的措施，旨在为临床诊疗和护理提供参考依据。

1资料与方法

1.1一般资料

选择2013年6月～2014年5月我院收治的老年AECOPD合……