住院之慢性阻塞性肺疾病患使用非侵性正壓呼吸器之成效

Outcome of in-patients with Chronic Obstructive Pulmonary Disease Requiring non-invasive Positive Pressure Ventilator

林碧華(Pi-Hua Lin) ； 陳寶貝(Pao-Pei Chen) ； 李俊德(Jiunn-Der Lee)

《呼吸治療》 8卷2期 (2009/07) Pp. 13-25

https://doi.org/10.6269/JRT.2009.8.2.02

摘要

Noninvasive positive pressure ventilation (NPPV) has been available in clinical application for patients with chronic obstructive pulmonary disease (COPD) in recent decades, but studies are controversial about the rationale, timing, and the effectiveness for COPD patients with NPPV. We conducted this study to discuss about the COPD patients with NPPV for 1) effectiveness in different indication, 2) the result of various respiratory acidosis severity of patients with NPPV, 3) the predictors of success during NPPV use.
A total of 82 COPD patients with NPPV were recruited in our hospital over 12 months. The successful rate, intubation rate and mortality rate was 75.6%, 18.3% and 6.1%, respectively. There was insignificant difference of intubation rate and mortality rate in the different indication of NPPV (various respiratory acidosis severity, post extubation or refusing endo-tracheal intubation),but the refusing endo-tracheal intubation group had higher mortality rate, and post extubation group had longer in hospital stay. Comparing the various severity of respiratory acidosis groups (PH＞ 7.35, PH≤7.35 to PH≥7.3 and PH＜7.3), there was no statistical significance in the intubation and mortality rate. Ability of expectoration was a successful factor of NPPV. The success group with NPPV had significantly improved in PH, PaCO2, GCS, respiratory and heart rate. On the contrary, the failure group increased PH and decreased PaCO2 initially, but the data reversed later, with worsening of GCS, respiratory and heart rate. There was no difference in the duration of NPPV use between success and failure groups, but hospital stay was obviously longer in failure group.

關鍵字

慢性阻塞性肺疾病 ； 非侵性正壓呼吸器 ； 昏迷指數

並列摘要

Noninvasive positive pressure ventilation (NPPV) has been available in clinical application for patients with chronic obstructive pulmonary disease (COPD) in recent decades, but studies are controversial about the rationale, timing, and the effectiveness for COPD patients with NPPV. We conducted this study to discuss about the COPD patients with NPPV for 1) effectiveness in different indication, 2) the result of various respiratory acidosis severity of patients with NPPV, 3) the predictors of success during NPPV use.
A total of 82 COPD patients with NPPV were recruited in our hospital over 12 months. The successful rate, intubation rate and mortality rate was 75.6%, 18.3% and 6.1%, respectively. There was insignificant difference of intubation rate and mortality rate in the different indication of NPPV (various respiratory acidosis severity, post extubation or refusing endo-tracheal intubation),but the refusing endo-tracheal intubation group had higher mortality rate, and post extubation group had longer in hospital stay. Comparing the various severity of respiratory acidosis groups (PH＞ 7.35, PH≤7.35 to PH≥7.3 and PH＜7.3), there was no statistical significance in the intubation and mortality rate. Ability of expectoration was a successful factor of NPPV. The success group with NPPV had significantly improved in PH, PaCO2, GCS, respiratory and heart rate. On the contrary, the failure group increased PH and decreased PaCO2 initially, but the data reversed later, with worsening of GCS, respiratory and heart rate. There was no difference in the duration of NPPV use between success and failure groups, but hospital stay was obviously longer in failure group.

並列關鍵字

COPD ； NPPV ； GCS