CAJ | 학술논문

目的探讨无创正压通气(NIPPV)治疗慢性阻塞性肺疾病急性加重(AECOPD)伴Ⅱ型呼吸衰竭患者时不同呼出气潮气量水平对通气效果的影响.方法选取伴Ⅱ型呼吸衰竭的住院患者45例,在常规治疗基础上,给予沙利文多功能双水平无创正压呼吸机(VPAPⅡST-A BI-LEVEL)辅助通气,观察患者呼出气潮气量,并根据呼出气潮气量将患者分为A、B、C三组,监测三组患者治疗前及治疗2h后的动脉血气、心率和呼吸频率变化.结果 A组患者,治疗前和治疗后2h的动脉血气分析和临床指标基本无变化(P＞0.05),PaCO2下降幅度小,仅下降1.02％,并有4例患者PaCO2不降反升,病情加重,给予气管插管和有创呼吸机辅助通气；B组与C组患者,辅助通气2h后动脉血气分析和临床指标明显改善,尤以PaCO2下降明显(P＜0.01),下降幅度超过20％.结论监测NIPPV治疗时患者呼出气潮气量,可以直接、及时反映通气效果,并指导通气参数的设置.
목적 탐토무창정압통기(NIPPV)치료만성조새성폐질병급성가중(AECOPD)반Ⅱ형호흡쇠갈환자시불동호출기조기량수평대통기효과적영향.방법 선취반Ⅱ형호흡쇠갈적주원환자45례,재상규치료기출상,급여사리문다공능쌍수평무창정압호흡궤(VPAPⅡST-A BI-LEVEL)보조통기,관찰환자호출기조기량,병근거호출기조기량장환자분위A、B、C삼조,감측삼조환자치료전급치료2h후적동맥혈기、심솔화호흡빈솔변화.결과 A조환자,치료전화치료후2h적동맥혈기분석화림상지표기본무변화(P＞0.05),PaCO2하강폭도소,부하강1.02％,병유4례환자PaCO2불강반승,병정가중,급여기관삽관화유창호흡궤보조통기；B조여C조환자,보조통기2h후동맥혈기분석화림상지표명현개선,우이PaCO2하강명현(P＜0.01),하강폭도초과20％.결론 감측NIPPV치료시환자호출기조기량,가이직접、급시반영통기효과,병지도통기삼수적설치.
Objective To investigate the influence of ventilatory effect caused by exhaled gas tidal volume during the treatment of noninvasive positive pressure ventilation (NIPPV) towards patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and Ⅱ respiratory failure.Methods 45 patients with AECOPD and type Ⅱ respiratory failure were selected in the study.Beside the basis of conventional therapy,the patients were also given ventilation by Sullivan's multi-function bi-level noninvasive positive pressure ventilator (VPAP Ⅱ ST-A,the BI-the LEVEL).We divided these patients into group A,B,C by their exhaled tidal volume (VTe).Then we monitored these patients' arterial blood gas,heart rate and breathing frequency before and after this treatment.Results Before and after the treatment,group A of arterial blood gas and clinical indicators are almost no change (P ＞0.05),and their PaCO2 is decreased 1.02％ only.4 patients in group A were given endotracheal intubation and invasive mechanical ventilation due to the increase of their PaCO2.After 2 hours 'ventilation treatment,group 13 and C patients' arterial blood gas and clinical parameters were significantly improved,especially PaCO2 decreased significantly (P ＜0.01),by more than 20％.Conclusions During NIPPV treatment,the patients' exhaled tidal volume is directly related to the ventilation effects,and they can be used to guide the ventilation parameter settings.