【BiPAP呼吸机辅助治疗COPD合并Ⅱ型呼吸衰竭52例临床护理体会】 二型呼吸衰竭用呼吸机

　　[摘要] 目的 探讨BiPAP呼吸机辅助治疗慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭患者的疗效和护理方法。 方法 将52例COPD合并Ⅱ型呼吸衰竭的患者在常规治疗的同时予以BiPAP呼吸机辅助治疗，并给予全面、周到、专业的护理，观察治疗前后患者动脉血气分析（pH、PaO2、PaCO2）和相关不良反应发生率，并调查患者及其家属对护理的满意度。 结果 患者的自觉症状改善较以往常规治疗明显且快，治疗结束时患者PaO2明显升高（t = 28.06，P < 0.01），PaCO2降低（t = 11.98，P < 0.01），pH改善明显（t = 10.07，P < 0.01）。7例患者出现与使用BiPAP呼吸机相关的轻度不良反应，但经积极对症治疗和合理护理均明显好转，患者总满意率为90.38%。 结论 BiPAP呼吸机辅助治疗COPD合并Ⅱ型呼吸衰竭具有迅速改善症状、有效纠正低氧和高碳酸血症和提高生存质量和优点，有较高的临床应用价值，但在临床应用中应当予以全面、周到、专业的护理。
　　[关键词] 双水平无创正压通气；慢性阻塞性肺疾病；Ⅱ型呼吸衰竭；护理
　　[中图分类号] R562 [文献标识码] C [文章编号] 1673-7210（2012）07（b）-0136-03
　　Nursing care of COPD complicted with type 2 respiratory failure treated with BiPAP ventilator adjunctive therapy
　　FAN Jingjing HU hongling
　　Department of Respiratory, Wuhan Central Hospital, Hubei Province, Wuhan 430014, China
　　[Abstract] Objective To explore the clinical effects and nursing methods of the bilevel positive airway pressure (BiPAP) adjunctive therapy in the treatment patients of chronic obstructive pulmonary disease (COPD) complicated with type Ⅱ respiratory failure. Methods On the basis of routine treatment such as oxygen and antibiotics, BiPAP ventilator was used for 52 COPD patients complicated with type Ⅱ respiratory failure. All patients received comprehensive and professional nursing. The change of their clinical features were observed, such as pH, PaO2, PaCO2, adverse reactions and satisfaction level of nursing from patients and their families. Results Symptoms were obviously and fast improved after treatment of BiPAP. The gas-blood analysis demonstrated that PaO2 significantly increased (t = 28.06, P < 0.01), PaCO2 decreased (t = 11.98, P < 0.01) and pH improved (t = 10.07, P<0.01). The mild ventilator associated adverse reactions were seen in 7 cases, but all patients were significantly improved after symptomatic treatment and proper nursing. Patients satisfaction rate was 90.38%. Conclusions BiPAP ventilator adjunctive therapy is a safe and effective therapeutic approach for COPD patients complicated with type Ⅱ respiratory failure, and comprehensive and professional nursing is very necessary.
　　[Key words] BiPAP; COPD; Type Ⅱ respiratory failure; Nursing
　　慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）是由于慢性支气管炎和/或肺气肿所导致的、以不完全可逆性气流受限为特征的的肺部疾病，其气流受限常呈进行性发展，可伴或不伴气道的高反应性。COPD常困为感染、吸入性刺激等因素导致病情急性加重，此时可发生缺氧和二氧化碳潴留，临床上即表现为Ⅱ型呼吸衰竭，其中16%～35%的患者有进行机械通气的必要[1]。现对我院2009年1月～2010年6月本科所收治的52例COPD合并Ⅱ型呼吸衰竭的患者在常规治疗的同时予以BiPAP呼吸机双水平无创正压通气治疗，并给予全面、周到、专业的护理，取得了满意的临床疗效和护理效果，现报道如下：