Objective To study the clinical feasibility of invasive mechanical ventilation with bilevel positive airway pressure（BiPAP） non-invasive ventilator in the stable patients needing prolonged mechanical ventilation.Methods Eleven patients with respiratory failure admitted in intensive care unit（ICU）of our department，who needed prolonged mechanical ventilation，between Jun 2004 and Nov 2007 were enrolled in the study and followed until death or Jan 2008.The arterial blood gas analysis data，length of stay(LOS)，LOS after changing to BiPAP non-invasive ventilator（Synchrony，Harmony，RESPIRONICS，VPAP III ST-A，RESMED），survival time after discharge(or fulfilled the discharge standards) were reviewed retrospectively.Results The settings of inspiratory pressure，expiratory pressure and respiratory rate of non-invasive ventilation were 21.3 (16-26) cm H2O，4 cm H2O，and 16 min-1，respectively.The LOS (or up to the discharge standard) was (91.5±50.2) days.The LOS (or up to the discharge standard) after changing to BiPAP ventilator was (23.5±12.2) days.The mean survival time after discharge (or up to the discharge standard) was (353.1±296.5) days.Four patients were still alive up to the end of the study.The arterial pH，PaCO2，PaO2，and SaO2 were not significant different before and after changing to BiPAP ventilator.Conclusion The mechanical ventilation with BiPAP non-invasive ventilator via tracheotomy tube is an alternative choice for stable patients needing prolonged mechanical ventilation.
Objective To explore the efficacy of bi-level positive airway pressure ( BiPAP)ventilation plus plateau exhalation valve ( PEV) combined with respiratory stimulant for the treatment of pulmonary encephalopathy in patients with acute exacerbation of chronic obstructive pulmonary disease( AECOPD) . Methods 70 AECOPD patients with pulmonary encephalopathy were randomly divided into a control group and a treatment group. All patients received BiPAP ventilation and conventional therapyincluding antimicrobial, bronchodilation, and expectorant treatment. In the treatment group, the BiPAP ventilator was connected to PEV additionally, and naloxone and nikethamide were administered for 3 days.Clinical symptoms, blood gas analysis, vital signs, gas leakage conditions, and adverse reactions were recorded. Results Heart rate, respiratory rate, PaCO2 , and APACHEⅡ score were more significantly lower,the time to recover consciousness was shoter, meanwhile PaO2 , SaO2 , pH, and glasgow coma scale were significantly higher in the treatment group compared with the control group( all P lt; 0. 01) . Two cases in the treatment group and 5 cases in the control group received tracheal intubation and invasive ventilation due to treatment failure. Two elderly patients in the control group died in hospital. Conclusion Noninvasive positive pressure ventilation plus PEV combined with respiratory stimulant can significantly improve symptoms, shorten the time to recover consciousness, reduce the rate of endotracheal intubation, and improve hypoxemia and hypercapnia rapidly in AECOPD patients with pulmonary encephalopathy.
目的:评价经口鼻面罩双水平气道正压通气(BiPAP)治疗慢性阻塞性肺疾病急性加重期(AECOPD)并发Ⅱ型呼吸衰竭的临床疗效。〖HTH〗方法〖HTSS〗:对照组30例AECOPD并Ⅱ型呼吸衰竭患者给予吸氧、抗感染、化痰平喘等常规治疗,观察组38例AECOPD并Ⅱ型呼吸衰竭患者,在常规治疗的基础上同时进行BiPAP通气治疗。观察两组治疗前及治疗后4 h、24 h及72 h动脉血气变化,比较治疗前后呼吸频率、心率和白细胞计数以及血浆内皮素-1含量的变化,观察两组住院时间、气管插管率及病死率的变化。结果:观察组治疗后4 h、24 h及72 h动脉血气pH、PaO2、SaO2、PaO2/FiO2均明显高于对照组(Plt;0.05),PaCO2明显下降(Plt;0.05)。呼吸频率、心率和白细胞计数较对照组均下降(Plt;0.05)。观察组血浆内皮素-1含量恢复至正常水平快于对照组,观察组和对照组患者住院时间、气管插管率及病死率均有显著性差异(Plt;0.05)。〖HTH〗结论〖HTSS〗:BiPAP治疗慢性阻塞性肺疾病急性加重期并发Ⅱ型呼吸衰竭患者疗效确切,能减少住院时间、降低插管率和病死率。
目的:探讨鼻(面)罩无创双水平气道正压通气(BiPAP)在慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的治疗作用。方法:入选病例60例,分为常规治疗组28例,采用常规治疗;呼吸机治疗组32例,在常规资料基础上加用BiPAP无创呼吸机治疗,两组患者心率,呼吸频率,血气分析比较。结果:呼吸机治疗组患者心率,呼吸频率,血气分析的改善优于常规治疗组,差异有统计学意义(Plt; 0.05)。结论:无创双水平气道正压机械通气辅助治疗COPD合并Ⅱ型呼吸衰竭具有肯定的疗效,能更快地缓解患者的临床症状;提高PaO2,SaO2和降低PaCO2;能更好地促进病情的恢复,减少住院时间。