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題 名 | 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 |
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作 者 | 林碧華; 陳寶貝; 李俊德; | 書刊名 | 呼吸治療雜誌 |
卷 期 | 8:2 2009.07[民98.07] |
頁 次 | 頁13-25 |
分類號 | 415.428 |
關鍵詞 | 慢性阻塞性肺疾病; 非侵性正壓呼吸器; 昏迷指數; COPD; NPPV; GCS; |
語 文 | 中文(Chinese) |
中文摘要 | 最近十幾年來臨床上使用NPPV治療COPD患者巳日漸普及,但何時該建議COPD病患使用NPPV及其成敗評估,各學者觀點不一。爲了探討COPD病患與NPPV間(1)不同使用原因的成效、(2)不同嚴重度呼吸性酸血症的治療結果及(3)影響成敗的因子,我們進行此研究。結果顯示本院96年度COPD患者使用NPPV且符合研究條件者共有82人次,其成功率爲75.6%、失敗插回氣管內管使用呼吸器者有18.3%、病危自動出院或院內死亡者有6.1%。三種不同使用因素(呼吸性酸血症、拔管脫離呼吸器或濱臨呼吸衰竭卻拒絕插管)皆不影響成功率,但拒絕插管者其院內死亡率較高,拔管脫離呼吸器後使用NPPV患者其住院天數偏高。不同嚴重度呼吸性酸血症(PH>7.35組、PH≤7.35至PH≥7.3組及PH<7.3組)使用NPPV治療後其插氣管內管率及院內死亡率均無統計意義。病人可否自行清除痰液會影響治療成敗。使用NPPV成功組其PH上升、PaCO2下降,且GCS、每分鐘呼吸及心跳次數都有明顯改善。失敗組經治療後PH值上升及PaCO2值下降,但之後又再度逆轉,GCS指數下降、每分鍾呼吸次數及心跳次數增加。失敗組相對於成功組使用NPPV天數沒有差異性,但住院天數卻明顯的大於成功組。 |
英文摘要 | 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. |
本系統中英文摘要資訊取自各篇刊載內容。