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目的:评价无创正压通气用于高海拔地区重症呼衰合并多脏器功能障碍(MODS)的治疗效果。方法:回顾性研究重症呼衰伴多脏器功能障碍18例,起源于慢性阻塞性肺疾病急性加重后(AECOPD)15例,危重急诊术后引起的Ⅰ型呼衰3例,均应用无创正压通气,列为NPPV组(n=18);另选14例病情较轻,未接受NPPV治疗者列为对照组(non-NPPV组,n=14)。结果:NPPV组治疗前临床症状、血气参数、多脏器损害数量明显重于non-NPPV组(P<0.05),最终治疗结果却优于non-NPPV组,住院天数也少于non-NPPV组。结论:高海拔地区应用NPPV不论对AECOPD引起的Ⅱ型呼衰或创伤感染后导致的Ⅰ型呼衰均可明显减轻临床症状,改善低氧水平,降低合并症、住院天数及病死率;对比结果还表明,在高海拔地区早期应用NPPV可能是遏制重症呼衰导致MODS的一项重要措施。
Objective: To evaluate the therapeutic effect of non-invasive positive pressure ventilation on severe respiratory failure with multiple organ dysfunction (MODS) in high altitude areas. Methods: A retrospective study of 18 cases of severe respiratory failure with multiple organ dysfunction, originated in 15 cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), 3 cases of type Ⅰ respiratory failure after critical emergency surgery, were noninvasive positive Ventilation was classified as NPPV (n = 18). Another 14 patients were selected as non-NPPV patients (n = 14). Results: Before treatment, the clinical symptoms, blood gas parameters and the number of multiple organ damage in NPPV group were significantly higher than those in non-NPPV group (P <0.05). The final treatment was superior to non-NPPV group and hospital stay was also less than that of non-NPPV group . Conclusion: Application of NPPV in high altitude area can reduce clinical symptoms, improve hypoxia level, reduce comorbidities, length of hospital stay and mortality of type Ⅰ respiratory failure caused by AECOPD or type Ⅰ respiratory failure caused by wound infection. Comparing the results It has also been shown that the early application of NPPV in high altitudes may be an important measure to contain MODS caused by severe respiratory failure.