钟春苗 嵇朝晖 周萍萍 胡先全 傅恺

[摘要] 目的 探討慢性阻塞性肺疾病急性加重（AECOPD）合并呼吸衰竭应用无创通气序贯（NIPPV）治疗的临床价值。 方法 选择2015年7月～2017年7月浙江省湖州市第一人民医院收治的120例AECOPD合并呼吸衰竭患者，采用随机数字表法分为两组，每组各60例。对照组采用常规有创正压通气技术（IPPV），观察组采用NIPPV通气支持。比较两组患者临床指标、生命体征、血浆N端脑利钠肽前体（NT-proBNP）、肺部感染与健康状况。 结果 观察组重症监护时间、总机械通气时间与有创通气时间均短于对照组，差异有统计学意义（P < 0.05）。观察组患者再插管率为3.33%（2/60），呼吸机相关性肺炎（VAP）发生率为3.33%（2/60），对照组再插管率为15.00%（9/60），VAP发生率为16.67%（10/60），两组比较差异有统计学意义（P < 0.05）。观察组患者心率（HR）、呼吸频率（RR）、血二氧化碳分压（PaCO2）水平均低于对照组，pH与血氧分压（PaO2）水平高于对照组，差异有统计学意义（P < 0.05）。治疗前，两组患者血浆NT-proBNP水平、肺临床感染评分（CPIS）与急性生理与慢性健康评分（APACHE-Ⅱ）比较，差异无统计学意义（P > 0.05）。治疗后，观察组患者血浆NT-proBNP水平、CPIS与APACHE-Ⅱ评分均低于对照组，差异有统计学意义（P < 0.05）。 结论 针对AECOPD合并呼吸衰竭患者，采用NIPPV治疗利于缩短通气治疗时间，改善患者生命体征，降低肺部感染风险，维护患者健康状态，增强临床疗效。

[关键词] 感染；呼吸衰竭；无创通气序贯治疗；有创正压通气技术；生命体征

[中图分类号] R563.9 [文献标识码] A [文章编号] 1673-7210（2018）05（b）-0089-05

Effect of sequential non-invasive ventilation for acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure

ZHONG Chunmiao JI Zhaohui ZHOU Pingping HU Xianquan FU Kai

Emergency Department， the First People's Hospital of Huzhou City， Zhejiang Province， Huzhou 313000， China

[Abstract] Objective To explore the clinical value of noninvasive ventilation sequential （NIPPV） in the treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） combined with respiratory failure. Methods One hundred and twenty patients with AECOPD complicated with respiratory failure treated in the First People's Hospital of Huzhou City from July 2015 to July 2017 were selected and they were divided into two groups by random number table， with 60 cases in each group. The control group received conventional invasive positive pressure ventilation （IPPV） and the observation group received NIPPV support. Clinical indicators， vital signs， N-terminal pro-brain natriuretic peptide （NT-proBNP）， pulmonary infection and health status were compared between the two groups. Results The durations of intensive care， total duration of mechanical ventilation and invasive ventilation in the observation group were all shorter than those in control group， with statistically significant differences （P < 0.05）. In observation group， the re-intubation rate was 3.33% （2/60） and the incidence of ventilator-associated pneumonia （VAP） was 3.33% （2/60）， while in the control group， the re-intubation rate was 15.00% （9/60） and the incidence of VAP was 16.67% （10/60）， the differences between the two groups were statistically significant （P < 0.05）. The levels of heart rate （HR）， respiratory rate （RR） and partial pressure of carbon dioxide （PaCO2） in the observation group were lower than those in the control group， and the levels of pH and partial pressure of blood oxygen （PaO2） were higher than those in the control group （P < 0.05）. Before treatment， the levels of NT-proBNP， clinical pulmonary infection score （CPIS） and acute physiology and chronic health evaluation （APACHE-Ⅱ） scores of lung infection in the two groups showed no significant differences （P > 0.05）. After treatment， the levels of NT-proBNP， CPIS and APACHE-Ⅱ scores in the observation group were lower than those in the control group， with significant differences （P < 0.05）. Conclusion For patients with AECOPD complicated with respiratory failure， NIPPV can help to shorten the ventilation duration， improve their vital signs， reduce the risk of lung infection， maintain good health status and enhance the clinical efficacy.

[Key words] Infection； Respiratory failure； Noninvasive ventilation sequential therapy； Invasive positive pressure ventilation technique； Vital signs

慢性阻塞性肺疾病急性加重期（acute exacerbations of chronic obstructive pulmonary disease，AECOPD）合并呼吸衰竭属于常见的临床慢性呼吸系统疾病，具有高发病率与高死亡率[1-2]。机械通气为该疾病最为有效的治疗方法，但长期进行有创呼吸创伤较大，且人工气道护理难度较高，容易给患者带来诸多痛苦，降低免疫力，增加出现呼吸机相关性肺炎（ventilator associated pneumonia，VAP）等院内感染事件的概率，进而降低治疗效果[3-4]。有创正压通气是一种通过经鼻气管插管或气管切开后建立人工气道，临床疗效确切，但有研究表明[5]，有创正压通气会增加患者VAP的发生率，导致患者机械通气时间延长以及撤机困难。无创通气序贯（nasal intermittent positive pressure ventilation，NIPPV）是通过口鼻面罩或全面罩等无创方式实施正压的辅助通气方式。……