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《Chinese Journal of Clinical Medicine》 2006-02
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The Effect of Noninvasive Positive-Pressure Ventilation on Arterial-blood Gas in Patients with Severe Respiratory Failure

OUYANG Xiuhe YU Liping ZHENG Wentao et al.Department of Respiratory Disease,Bin zhou Municipal People's Hospital in Shandong Province,Binzhou 256610  
Objective:We conducted a prospective, randomized trial of BiPAP noninvasive positive-pressure ventilation as compared with endotracheal intubation or tracheotomy with conventional mechanical ventilation in patients with severe respiratory failure who required mechanical ventilation, and the arterial-blood gas value improvement was compared. Methods: According to the arterial-blood gas value, and consciousness determined at baseline, severe patients of COPD with respiratory failure were included. Patients were assigned into treatment group control group, the treatment group were received noninvasive ventilation, and control group were treated with conventional mechanical ventilation. Medical management for the conditions, which consist of anti-infection, and general medical therapy, ect, were similar in the two groups. All patients underwent continuous electrocardiography and monitoring of arterial oxygen saturation. Arterial-blood gas value were determined at baseline, at 2-3 hour, at six-hour, 24-hour and 72-hour intervals during mechanical ventilation, and before discontinuation of ventilatory support. Consciousness, breathe, heart rate, blood pressure were observed during the treating period. Results: 52 patients were enrolled in the study 29 in the treatment group,while 23 in the wound group. In treatment , 2 subjects quit treatment required by his family, 2 subjects switched to endotracheal intubation and convention al ventilatilation , 1 died,, the other 24 subjects recoverd after noninvasive ventilation. The length of ventilation was 7.6±5.4d,the time of consciousness recover was 4. 8±3. 8(2-22)hour,the length of stay in the hospital was 13. 3±5. 8d. In control group, 6 cases were noninvasive ventilated for refusal of endotracheal intubation, 2 subjects quit treatment, 2 died, 13 subjects recovered after conventional mechanical ventilation. The length of ventilation was 6.5±6.2d ( vs treatment group, P0.05), the time of consciousness recover was 4.5±2.6(2~11)hour ( vs treatment group, P0. 05),the duration of stay in the hospital was 12. 2±8. 8d ( vs treatment group, P0.05). The patients in the two groups had a similar initial change in PaO2:FiO2,PaCO2 and heart rate . 4 patients facial-skin breakdown (especially at the bridge of the nose), 5 cases gastric distention in treatment group. While 4 patients had ventilator-associated pneumonia, 4cases had gastric distention in control group. Conclusion: We found that noninvasive ventilation was as effective as conventional ventilation, especially in improving gas exchange in patients with sever respiratory failure, and was associated with fewer serious complications that ventilator-associated pneumonia.
【CateGory Index】: R563.8
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