中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2001年
2期
107-109
,共3页
刘励军%蒋志彬%余世全%沈斌%吴曙华%Sauder P%Jaeger A
劉勵軍%蔣誌彬%餘世全%瀋斌%吳曙華%Sauder P%Jaeger A
류려군%장지빈%여세전%침빈%오서화%Sauder P%Jaeger A
非呼吸系统病理因素%面罩正压机械通气%慢性阻塞性肺疾病,急性发作期%临床疗效
非呼吸繫統病理因素%麵罩正壓機械通氣%慢性阻塞性肺疾病,急性髮作期%臨床療效
비호흡계통병리인소%면조정압궤계통기%만성조새성폐질병,급성발작기%림상료효
目的：试图阐明非呼吸系统病理因素对面罩正压机械通气（NIPPV）治疗慢性阻塞性肺疾病（COPD）急性发作期患者临床疗效的影响。方法：根据NIPPV最终治疗效果，将患者分为有效组与无效组，比较2组非呼吸系统病理因素的差异，分析无效组患者最终放弃NIPPV治疗措施的原因。[HTH结果：进入研究的58例COPD急性发作期患者，有效组与无效组患者呼吸系统的基本病理状态、基础治疗以及进入ICU时血气分析结果无明显差别。但是，经过仅1个小时的NIPPV治疗后，有效组患者的高碳酸血症及呼吸性酸中毒得到明显改善。NIPPV治疗前无效组患者血浆白蛋白浓度〔(32.5±7.2)g/L〕明显低于有效组〔(37.2±5.0)g/L〕。无效组中47.1%的患者是非直接的呼吸系统因素(循环状态恶化、烦躁和消化系统紊乱)导致最终放弃NIPPV治疗，而行气管插管后的机械通气治疗。结论：对于COPD急性发作期患者，在实施NIPPV治疗的同时，积极控制感染、纠正低蛋白血症及内环境紊乱，尤其是加强循环系统监护治疗，将有助于提高NIPPV治疗的成功率。
目的：試圖闡明非呼吸繫統病理因素對麵罩正壓機械通氣（NIPPV）治療慢性阻塞性肺疾病（COPD）急性髮作期患者臨床療效的影響。方法：根據NIPPV最終治療效果，將患者分為有效組與無效組，比較2組非呼吸繫統病理因素的差異，分析無效組患者最終放棄NIPPV治療措施的原因。[HTH結果：進入研究的58例COPD急性髮作期患者，有效組與無效組患者呼吸繫統的基本病理狀態、基礎治療以及進入ICU時血氣分析結果無明顯差彆。但是，經過僅1箇小時的NIPPV治療後，有效組患者的高碳痠血癥及呼吸性痠中毒得到明顯改善。NIPPV治療前無效組患者血漿白蛋白濃度〔(32.5±7.2)g/L〕明顯低于有效組〔(37.2±5.0)g/L〕。無效組中47.1%的患者是非直接的呼吸繫統因素(循環狀態噁化、煩躁和消化繫統紊亂)導緻最終放棄NIPPV治療，而行氣管插管後的機械通氣治療。結論：對于COPD急性髮作期患者，在實施NIPPV治療的同時，積極控製感染、糾正低蛋白血癥及內環境紊亂，尤其是加彊循環繫統鑑護治療，將有助于提高NIPPV治療的成功率。
목적：시도천명비호흡계통병리인소대면조정압궤계통기（NIPPV）치료만성조새성폐질병（COPD）급성발작기환자림상료효적영향。방법：근거NIPPV최종치료효과，장환자분위유효조여무효조，비교2조비호흡계통병리인소적차이，분석무효조환자최종방기NIPPV치료조시적원인。[HTH결과：진입연구적58례COPD급성발작기환자，유효조여무효조환자호흡계통적기본병리상태、기출치료이급진입ICU시혈기분석결과무명현차별。단시，경과부1개소시적NIPPV치료후，유효조환자적고탄산혈증급호흡성산중독득도명현개선。NIPPV치료전무효조환자혈장백단백농도〔(32.5±7.2)g/L〕명현저우유효조〔(37.2±5.0)g/L〕。무효조중47.1%적환자시비직접적호흡계통인소(순배상태악화、번조화소화계통문란)도치최종방기NIPPV치료，이행기관삽관후적궤계통기치료。결론：대우COPD급성발작기환자，재실시NIPPV치료적동시，적겁공제감염、규정저단백혈증급내배경문란，우기시가강순배계통감호치료，장유조우제고NIPPV치료적성공솔。
To illustrate the effect of nonrespiratory pathogenic factors onclinical outcome of treatment by face[ CD2 mask positive pressure mechanical ventilation (NIPPV) for chronic obst ructive pulmonary disease (COPD) patients during acute stage.Methods:Patients were divided into effective and ineffective groups according to the final results of NIPPV treatment.Differences in nonrespiratory pathoge nic factors between effective and ineffective groups were compared,and the reaso ns with regard to termination of NIPPV treatment were analyzed in ineffective group.Results:There were no significant differences in basic pathological state of respiratory system,elementary treatment and blood gas analysis between the two groups in 58 COPD patients when admitted to ICU.After onehour NIPPV treatment,ho wever,hypercapnia and respiratory acidosis were apparently improved in effective group.The blood albumin in ineffective group was significantly lower than that of the effective group〔(32.5±7.2）g/L vs.（37.2±5.0）g/L〕.The reasons related to termination of NIPPV treatment showed that 47.1% patients underwent intubation as a result of nonrespiratory pathologic factors.Conclusions:For the COPD patients during acute stage,amelioration of low blood albumin and anxiety,and circulation support would be useful for the successful implementation of NIPPV treatment.
