无创性机械通气在治疗肺结核合并呼吸衰竭中的临床疗效(1)
[摘要] 目的 探讨无创性机械通气在治疗肺结核合并呼吸衰竭中的临床疗效。 方法 回顾性分析2011年11月～2014年11月黑龙江省传染病防治院收治的76例肺结核合并呼吸衰竭患者的临床资料。患者均给予常规治疗，如抗感染、祛痰，针对基础疾病和并发症治疗。在此基础上实施无创性机械通气治疗。比较患者治疗前后PaO2、PaCO2、pH值变化。 结果 治疗后出现2例患者死于大咯血，4例患者因经济原因放弃治疗，其他患者均无不良反应，有效率为92.11%。治疗后PaO2和PEF明显升高，PaCO2明显下降，pH值趋近正常，较治疗前明显改善，差异有统计学意义(P<0.05)。 结论 无创性机械通气在治疗肺结核合并呼吸衰竭中疗效满意，安全，无明显并发症，易于患者接受。
[关键词] 无创性机械通气；肺结核；呼吸衰竭
[中图分类号] R521；R563.8 [文献标识码] B [文章编号] 2095-0616(2015)17-189-03
, 百拇医药
Clinical effect of noninvasive ventilation in the treatment of pulmonary tuberculosis with respiratory failure
ZHANG Hanwen
Departmeng of ICU，Infectious Diseases Prevention and Control Hospital of Heilongjiang Province，Harbin 150500，China
[Abstract] Objective To explore the clinical efficacy of noninvasive ventilation in the treatment of pulmonary tuberculosis with respiratory failure. Methods The clinical data of 76 patients with pulmonary tuberculosis with respiratory failure，who were in hospital from November 2011 to November 2014，were retrospectively analyzed.All patients were given conventional treatment， such as anti infection， eliminating phlegm，for the treatment of underlying diseases and complications.On the basis，patients were given noninvasive mechanical ventilation treatment.PaO2，PaCO2，and pH were compared before and after treatment. Results After treatment，2 patients died of massive hemoptysis，4 patients due to economic reasons to give up treatment.Other patients had no adverse reaction，the efficiency was 92.11%.After treatment，PaO2 and PEF of other patients were significantly elevated，PaCO2 decreased significantly，and the pH value reaching normal.Observation indexes were compared with those before treatment significantly improved(P<0.05). Conclusion Noninvasive ventilation in the treatment of pulmonary tuberculosis complicated with respiratory failure is satisfactory，safe and has no obvious complications，and is easy to be accepted by patients.
, 百拇医药
[Key words] Noninvasive ventilation；Pulmonary tuberculosis；Respiratory failure
世界卫生组织(WHO)统计表明，我国是世界上结核病疫情最严重的国家之一，特别是耐多药的结核病流行严重，同时是单因素致死率最高的传染性疾病[1]。肺结核是由结核分枝杆菌引起的慢性传染病，呼吸衰竭是终末期肺结核患者常常出现的症状，肺结核合并呼吸衰竭患者常因疾病的原因而无法进行正常呼吸，以致危及生命，因此，建立人工气道进行辅助或控制性机械通气是治疗的重要措施。无创机械通气(noninvasive ventilation，NIV)是指通过鼻罩或口鼻面罩等方法连接呼吸机，无需建立人工气道。经面罩无创正压通气(noninvasive positive-pressure ventilation，NPPV)具有降低PaCO2，减轻呼吸困难的作用，降低创伤性治疗的机率，并具有提高生活质量等特点[2-3]。黑龙江省传染病防治院采用无创性机械通气治疗肺结核合并呼吸衰竭，取得了满意效果，现报道如下。
1 资料与方法
1.1 一般资料
回顾性分析2011年11月～2014年11月黑龙江省传染病防治院收治的76例肺结核合并呼吸衰竭患者临床资料，其中男49例、女27例，年龄40～75岁，平均(56.7±11.4)岁。病史5～22年，平均(8.8±3.7)年。所有患者均符合肺结核中华医学会结合分会2001年制定的诊断标准[4]。所有患者血气分析PaO2<60mm Hg，PaCO2>50mm Hg，达到Ⅱ型呼吸衰竭诊断标准[5]，新出现的意识障碍。排除常见气道阻塞性疾病如COPD、支气管哮喘、支气管扩张等引起的呼吸衰竭，均无严重心脏病等机械通气禁忌证。, http://www.100md.com(张瀚文)
[关键词] 无创性机械通气；肺结核；呼吸衰竭
[中图分类号] R521；R563.8 [文献标识码] B [文章编号] 2095-0616(2015)17-189-03
, 百拇医药
Clinical effect of noninvasive ventilation in the treatment of pulmonary tuberculosis with respiratory failure
ZHANG Hanwen
Departmeng of ICU，Infectious Diseases Prevention and Control Hospital of Heilongjiang Province，Harbin 150500，China
[Abstract] Objective To explore the clinical efficacy of noninvasive ventilation in the treatment of pulmonary tuberculosis with respiratory failure. Methods The clinical data of 76 patients with pulmonary tuberculosis with respiratory failure，who were in hospital from November 2011 to November 2014，were retrospectively analyzed.All patients were given conventional treatment， such as anti infection， eliminating phlegm，for the treatment of underlying diseases and complications.On the basis，patients were given noninvasive mechanical ventilation treatment.PaO2，PaCO2，and pH were compared before and after treatment. Results After treatment，2 patients died of massive hemoptysis，4 patients due to economic reasons to give up treatment.Other patients had no adverse reaction，the efficiency was 92.11%.After treatment，PaO2 and PEF of other patients were significantly elevated，PaCO2 decreased significantly，and the pH value reaching normal.Observation indexes were compared with those before treatment significantly improved(P<0.05). Conclusion Noninvasive ventilation in the treatment of pulmonary tuberculosis complicated with respiratory failure is satisfactory，safe and has no obvious complications，and is easy to be accepted by patients.
, 百拇医药
[Key words] Noninvasive ventilation；Pulmonary tuberculosis；Respiratory failure
世界卫生组织(WHO)统计表明，我国是世界上结核病疫情最严重的国家之一，特别是耐多药的结核病流行严重，同时是单因素致死率最高的传染性疾病[1]。肺结核是由结核分枝杆菌引起的慢性传染病，呼吸衰竭是终末期肺结核患者常常出现的症状，肺结核合并呼吸衰竭患者常因疾病的原因而无法进行正常呼吸，以致危及生命，因此，建立人工气道进行辅助或控制性机械通气是治疗的重要措施。无创机械通气(noninvasive ventilation，NIV)是指通过鼻罩或口鼻面罩等方法连接呼吸机，无需建立人工气道。经面罩无创正压通气(noninvasive positive-pressure ventilation，NPPV)具有降低PaCO2，减轻呼吸困难的作用，降低创伤性治疗的机率，并具有提高生活质量等特点[2-3]。黑龙江省传染病防治院采用无创性机械通气治疗肺结核合并呼吸衰竭，取得了满意效果，现报道如下。
1 资料与方法
1.1 一般资料
回顾性分析2011年11月～2014年11月黑龙江省传染病防治院收治的76例肺结核合并呼吸衰竭患者临床资料，其中男49例、女27例，年龄40～75岁，平均(56.7±11.4)岁。病史5～22年，平均(8.8±3.7)年。所有患者均符合肺结核中华医学会结合分会2001年制定的诊断标准[4]。所有患者血气分析PaO2<60mm Hg，PaCO2>50mm Hg，达到Ⅱ型呼吸衰竭诊断标准[5]，新出现的意识障碍。排除常见气道阻塞性疾病如COPD、支气管哮喘、支气管扩张等引起的呼吸衰竭，均无严重心脏病等机械通气禁忌证。, http://www.100md.com(张瀚文)