郭林

摘 要 目的：探讨无创正压通气在不同病因所致急性呼吸衰竭（acute respiratory failure， ARF）治疗中的临床疗效。方法：选取50例因重症肺炎所致的ARF患者为A组，选取同期50例因心源性肺水肿所致的ARF患者为B组，所有患者均行无创正压通气治疗，比较两组患者的治疗效果、治疗前后血气指标及呼吸动力变化。结果：B组治疗总有效率显著高于A组，气管插管率、病死率及症状改善时间均显著少于A组（P<0.05）；治疗前后两组患者pH及每分通气量比较无显著性差异（P>0.05），治疗后两组患者的PaO2、SaO2及自主呼吸潮气量均明显升高，PaCO2、心率、呼吸频率及浅速呼吸指数均显著降低（P<0.05）。结论：无创正压通气在不同病因所致ARF治疗中均具有一定成效，且安全性较高，尤其在心源性肺水肿所致的中具有较高应用价值。

关键词 无创正压通气 急性呼吸衰竭 血气指标 呼吸动力

中图分类号：R563.8 文献标志码：B 文章编号：1006-1533（2018）15-0042-03

Noninvasive positive pressure ventilation for acute respiratory failure due to different etiologies

GUO Lin

（Department of Emergency， the Hospital affiliated to Leshan Vocational & Technical College， Sichuan Leshan 614000， China）

ABSTRACT Objective： To explore the clinical effects of noninvasive positive pressure ventilation for acute respiratory failure （ARF） due to different etiologies. Methods： Fifty patients with ARF caused by severe pneumonia were selected as group A and another 50 patient with ARF caused by cardiogenic pulmonary edema were selected as group B. All the patients were given noninvasive positive pressure ventilation and the effects and the changes of blood-gas parameters and respiratory mechanics were compared. Results： The total effective rate was significant higher and the rate of endotracheal intubation， the mortality and the time for symptom improvement were obviously less in group B than group A （P<0.05）. No significant differences in pH value and ventilation per minute were found in the two groups before and after treatment （P>0.05）. PaO2， SaO2 and self-breathing tidal volume were significantly increased and PaCO2， heart rate， respiratory rate and shallow breathing index were significantly decreased in the two groups after treatment （P<0.05）. Conclusion： Noninvasive positive pressure ventilation for the treatment of ARF caused by different etiologies possesses certain effectiveness with high safety and shows high applicable value especially in ARF caused by cardiogenic pulmonary edema.

KEY WORDS noninvasive positive pressure ventilation； acute respiratory failure； blood-gas parameters； respiratory mechanics

急性呼吸衰竭（acute respiratory failure， ARF）是急診科的常见病、多发病，临床常见症状为代谢功能紊乱、呼吸窘迫、节律异常等，若未进行及时有效治疗，将直接威胁到患者的生命安全。针对ARF临床上主要以改善微循环、保持气道通畅、纠正机体缺氧状态为治疗目的[1]。无创正压通气（non invasive positive pressure ventilation， NIPPV）是一种不经人工气道的通气方式，具有通气效果好、并发症少的优点，近年来被临床广泛应用于各类呼吸系统疾病的治疗中[2]。本研究选取100例ARF患者为研究对象，探讨NIPPV在不同病因所致ARF治疗中的临床疗效。

1 资料与方法

1.1 一般资料

选取2014年8月—2018年1月我院收治的50例因重症肺炎所致的ARF患者作为A组，其中男27例，女23例，年龄53～78岁，平均年龄（65.43±3.32）岁；体重48～83 kg，平均体重（58.73±2.49）kg；发病至就诊时间1～5 h，平均（2.63±0.28）h。选取同期我院收治的50例因心源性肺水肿所致的ARF患者作为B组，其中男26例，女24例，年龄52～80岁，平均年龄（65.37±3.28）岁；……