国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
INTERNATIONAL JOURNAL OF RESPIRATION
2008年
11期
650-654
,共5页
无创通气%慢性阻塞性肺疾病急性加重%呼吸衰竭伴意识障碍%纤维支气管镜%肺泡灌洗
無創通氣%慢性阻塞性肺疾病急性加重%呼吸衰竭伴意識障礙%纖維支氣管鏡%肺泡灌洗
무창통기%만성조새성폐질병급성가중%호흡쇠갈반의식장애%섬유지기관경%폐포관세
Noninvasive positive pressure ventilation%Acute exacerbation of chronic obstructive pulmonary disease%Consciousness disorder secondary to respiratory failure%Fiberoptic bronchoscopy%Bronchoalveolar lavage
目的 探讨无创通气(noninvasive positive pressure ventilation,NIPPV)联合纤维支气管镜肺泡灌洗术治疗对慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)并呼吸衰竭伴意识障碍患者的临床疗效及安全性.方法 对入选的30例伴意识障碍和32例不伴有意识障碍的AECOPD并呼吸衰竭患者,均无应用机械通气治疗病史,在年龄、性别、病程、体质量指数匹配的情况下分为治疗组和对照组.两组患者均无机械通气禁忌证.在接受常规抗炎、平喘药物治疗的同时进行NIPPV治疗.治疗组采用NIPPV治疗的同时配合纤维支气管镜肺泡灌洗治疗.观察两组治疗前后昏迷指数评分、血气变化、NIPPV时间、有效率、成功率、NIPPV序贯有创通气治疗成功率、病死率.结果 治疗组30例中,经NIPPV配合纤维支气管镜肺泡灌洗治疗成功19例,成功率63.3%,对照组32例中,NIPPV成功21例,成功率65.63%,两组对比差异无统计学意义(P＞0.05);血气分析两组治疗后较治疗前均明显好转,但治疗后两组对比差异无统计学意义(P＞0.05);无创与有创通气序贯治疗治疗组6例,成功4例,对照组7例,成功5例,两组无创与有创通气序贯治疗抢救成功率分别为66.67%和71.43%(P＞0.05);治疗组死亡5例,病死率16.67%,对照组死亡4例,病死率12.5%(P＞0.05).结论 AECOPD并呼吸衰竭伴意识障碍不是NIPPV的禁忌证.NIPPV联合纤维支气管镜肺泡灌洗治疗对意识障碍的患者同样可以首选NIPPV治疗,在进行NIPPV治疗之前进行纤维支气管镜肺泡灌洗术,可以获得与神志清醒患者相似的疗效.但必须由有经验的呼吸科专业医护人员和熟练的纤维支气管镜操作者密切配合与严密监护下进行,及时对病情作出事实评价,及早采取无创与有创通气序贯治疗,以免延误病情.
目的 探討無創通氣(noninvasive positive pressure ventilation,NIPPV)聯閤纖維支氣管鏡肺泡灌洗術治療對慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)併呼吸衰竭伴意識障礙患者的臨床療效及安全性.方法 對入選的30例伴意識障礙和32例不伴有意識障礙的AECOPD併呼吸衰竭患者,均無應用機械通氣治療病史,在年齡、性彆、病程、體質量指數匹配的情況下分為治療組和對照組.兩組患者均無機械通氣禁忌證.在接受常規抗炎、平喘藥物治療的同時進行NIPPV治療.治療組採用NIPPV治療的同時配閤纖維支氣管鏡肺泡灌洗治療.觀察兩組治療前後昏迷指數評分、血氣變化、NIPPV時間、有效率、成功率、NIPPV序貫有創通氣治療成功率、病死率.結果 治療組30例中,經NIPPV配閤纖維支氣管鏡肺泡灌洗治療成功19例,成功率63.3%,對照組32例中,NIPPV成功21例,成功率65.63%,兩組對比差異無統計學意義(P＞0.05);血氣分析兩組治療後較治療前均明顯好轉,但治療後兩組對比差異無統計學意義(P＞0.05);無創與有創通氣序貫治療治療組6例,成功4例,對照組7例,成功5例,兩組無創與有創通氣序貫治療搶救成功率分彆為66.67%和71.43%(P＞0.05);治療組死亡5例,病死率16.67%,對照組死亡4例,病死率12.5%(P＞0.05).結論 AECOPD併呼吸衰竭伴意識障礙不是NIPPV的禁忌證.NIPPV聯閤纖維支氣管鏡肺泡灌洗治療對意識障礙的患者同樣可以首選NIPPV治療,在進行NIPPV治療之前進行纖維支氣管鏡肺泡灌洗術,可以穫得與神誌清醒患者相似的療效.但必鬚由有經驗的呼吸科專業醫護人員和熟練的纖維支氣管鏡操作者密切配閤與嚴密鑑護下進行,及時對病情作齣事實評價,及早採取無創與有創通氣序貫治療,以免延誤病情.
목적 탐토무창통기(noninvasive positive pressure ventilation,NIPPV)연합섬유지기관경폐포관세술치료대만성조새성폐질병급성가중(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)병호흡쇠갈반의식장애환자적림상료효급안전성.방법 대입선적30례반의식장애화32례불반유의식장애적AECOPD병호흡쇠갈환자,균무응용궤계통기치료병사,재년령、성별、병정、체질량지수필배적정황하분위치료조화대조조.량조환자균무궤계통기금기증.재접수상규항염、평천약물치료적동시진행NIPPV치료.치료조채용NIPPV치료적동시배합섬유지기관경폐포관세치료.관찰량조치료전후혼미지수평분、혈기변화、NIPPV시간、유효솔、성공솔、NIPPV서관유창통기치료성공솔、병사솔.결과 치료조30례중,경NIPPV배합섬유지기관경폐포관세치료성공19례,성공솔63.3%,대조조32례중,NIPPV성공21례,성공솔65.63%,량조대비차이무통계학의의(P＞0.05);혈기분석량조치료후교치료전균명현호전,단치료후량조대비차이무통계학의의(P＞0.05);무창여유창통기서관치료치료조6례,성공4례,대조조7례,성공5례,량조무창여유창통기서관치료창구성공솔분별위66.67%화71.43%(P＞0.05);치료조사망5례,병사솔16.67%,대조조사망4례,병사솔12.5%(P＞0.05).결론 AECOPD병호흡쇠갈반의식장애불시NIPPV적금기증.NIPPV연합섬유지기관경폐포관세치료대의식장애적환자동양가이수선NIPPV치료,재진행NIPPV치료지전진행섬유지기관경폐포관세술,가이획득여신지청성환자상사적료효.단필수유유경험적호흡과전업의호인원화숙련적섬유지기관경조작자밀절배합여엄밀감호하진행,급시대병정작출사실평개,급조채취무창여유창통기서관치료,이면연오병정.
Objective To elucidate the effectiveness and safety of noninvasive positive pressure ventilation(NIPPV)associated with bronchoalveolar lavage(BAL)in consciousness disorder patients due to acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods Sixty-two acute exacerbation of COPD patients were divided into two groups,which were carefully matched for age,sex,COPD course,and body mass index(BMI)I.Thirty patients with impaired consciousness served as treatment group and 32 without impaired consciousness as control group.MV was never administered in these patients before and there were no contraindications.All patients received both NIPPV and standard medical treatment,BAL was administered in treatment group in addition.Changes from baseline in Glasgow coma scale,arterial blood gas (ABG)levels,duration of NIPPV,success rate of sequential invasive positive pressure ventilation(IPPV)and the mortality rate were compared.Results The success rate of NIPPV with BAL was 63.3%(19/30)in greatment group and the NIPPV success rate was 65.63%(21/32)in group B(P>0.05);ABG levels were improved obviously after treatment both in treatment group and controI group.but with no significant difference in ABG levels between treatment group and control group(P>0.05);6 cases received sequential IPPV in treatment group.and 7 cases in control group,the Success rate was 66.67%(4/6)and 71.43%(5/7)respectively(P>0.05);5 cases died in treatment group,and 4 cases in control group,the mortality was 16.67%(5/30)and 12.5%(4/32)respectively(P>0.05).Conclusions Consciousness disorder secondary to AECOPD should not be considered a contraindication to NIPPV.NIPPV can also be preferred in patients with excessive mucus production in conditions of administering NIPPV with BAL.In patients with impaired consciousness,NIPPV effectiveness may be similar to that in conscious patients if carrying OUt BAL before NIPPV.But the process must be monitored closely by experienced respiratory specialists'and the severity of the illness must be evaluated in time.If the disease deteriorates,sequential IPPV must be administered as early as possibly to avoid vicious incidents.
