CAJ | 학술논문

目的：比较鼻罩和面罩连接双水平气道正压力通气（BiPAP）在抢救Ⅱ型呼吸衰竭患者时的疗效，探索更好的无创通气连接模式。方法：选取2013年9月-2014年11月本院收治的80例AECOPD合并Ⅱ型呼吸衰竭患者作为研究对象，采用随机数字表法分为两组，观察组采用鼻罩连接无创通气，对照组采用面罩连接无创通气，两组患者均给予抗感染、祛痰、止咳、解痉、平喘、呼吸兴奋剂等治疗并在此基础上行BiPAP通气，观察比较通气前后两组生命体征、血气指标、依从率、成功率、插管率、住院天数及病死率。结果：两组通气后生命体征及血气指标均优于通气前；通气3 h后，对照组呼吸频率（R）、血氧饱和度（SpO2）及各项血气指标均优于观察组，观察组依从率及成功率均高于对照组，以上比较差异均有统计学意义（P<0.05）。两组插管率、住院时间及病死率比较差异均无统计学意义（P>0.05）。结论：鼻罩和面罩连接BiPAP通气对AECOPD合并Ⅱ型呼吸衰竭的患者均有显著效果，面罩连接比鼻罩连接更快改善R、SpO2及血气状况，但通气12 h后两种连接方式产生的效无明显差异，鼻罩连接的舒适性、依从性及成功率更好，更易于临床推广。
목적：비교비조화면조련접쌍수평기도정압력통기（BiPAP）재창구Ⅱ형호흡쇠갈환자시적료효，탐색경호적무창통기련접모식。방법：선취2013년9월-2014년11월본원수치적80례AECOPD합병Ⅱ형호흡쇠갈환자작위연구대상，채용수궤수자표법분위량조，관찰조채용비조련접무창통기，대조조채용면조련접무창통기，량조환자균급여항감염、거담、지해、해경、평천、호흡흥강제등치료병재차기출상행BiPAP통기，관찰비교통기전후량조생명체정、혈기지표、의종솔、성공솔、삽관솔、주원천수급병사솔。결과：량조통기후생명체정급혈기지표균우우통기전；통기3 h후，대조조호흡빈솔（R）、혈양포화도（SpO2）급각항혈기지표균우우관찰조，관찰조의종솔급성공솔균고우대조조，이상비교차이균유통계학의의（P<0.05）。량조삽관솔、주원시간급병사솔비교차이균무통계학의의（P>0.05）。결론：비조화면조련접BiPAP통기대AECOPD합병Ⅱ형호흡쇠갈적환자균유현저효과，면조련접비비조련접경쾌개선R、SpO2급혈기상황，단통기12 h후량충련접방식산생적효무명현차이，비조련접적서괄성、의종성급성공솔경호，경역우림상추엄。
Objective:To compare the effect of nasal mask and mask connected noninvasive ventilation with bi-level positive airway pressure(BiPAP)in the rescue of typeⅡrespiratory failure and to explore the better noninvasive ventilation connection mode.Method:80 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)combined with type II respiratory failure in our hospital from September 2013 to November 2014 were selected and randomly divided into two groups.All patients were given the basic treatment of anti infection,eliminating phlegm,relieving cough,spasmolysis,relieving asthma and respiratory stimulant.The two groups were given noninvasive ventilation with BiPAP on the basis of the basic treatment.The observation group was given nasal mask connection noninvasive ventilation and the control group was given mask connection noninvasive ventilation.The vital signs,indexes of blood gas,compliance rate,success rate,intubation rate,days of hospitalization and mortality rate of the two groups were observed and compared.Result:After ventilation,the vital signs and indexes of blood gas of the two groups were better than before ventilation.3 hours after the ventilation,the respiratory rate(R),oxygen saturation (SpO2)and indexes of blood gas in the control group were better than those in the observation group.The compliance rate and success rate of the observation group were higher than those of the control group.The differences above were all statistically significant(P<0.05).The differences in the intubation rate,days of hospitalization and mortality rate of the two groups were not statistically significant(P>0.05).Conclusion:The effect of nasal mask and mask connection noninvasive ventilation with BiPAP in the treatment of AECOPD complicated with typeⅡrespiratory failure is significant. The improvement of R,SpO2 and indexes of blood gas in patients with mask connection is faster than that in patients with nasal mask connection.But there is no significant difference in terms of the effect between the two connection methods after 12 hours of ventilation.Nasal mask connection is better in comfortability,compliance and the success rate,it is easier for clinical application.