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目的评价应用经口鼻面罩无创正压通气(NPPV)救治慢性阻塞性肺疾病(COPD)并重度呼吸衰竭伴神志障碍的疗效和安全性。方法前瞻性分析评价NPPV对COPD重度呼吸衰竭伴有神志障碍,且格拉斯哥昏迷评分(GCS)<10分的患者为研究组。格拉斯哥昏迷评分(GCS)>10分且没有神志障碍者为对照组。两组均接受NPPV,观察通气前、通气后2、24和72 h的呼吸频率、GCS评分和血气分析。结果神志障碍71例患者中51例经NPPV后经面罩通气后好转出院,20例患者需气管插管。无神志障碍54例患者中76%NPPV成功。结论NPPV不是对COPD重度呼吸衰竭伴有神志障碍患者的禁忌证。
Objective To evaluate the efficacy and safety of oral or nasal mask noninvasive positive pressure ventilation (NPPV) in the treatment of chronic obstructive pulmonary disease (COPD) and severe respiratory failure with psychiatric disorders. Methods A prospective analysis of NPPV patients with COPD severe respiratory failure associated with delirium and Glasgow Coma Scale <10 points was included in the study. Glasgow Coma Scale (GCS)> 10 points and no disability as a control group. NPPV was taken in both groups. The respiratory rate, GCS score and blood gas analysis before and after ventilation were observed at 2, 24 and 72 h. RESULTS: Among 71 patients with schizophrenia, 51 patients were discharged after being ventilated by the mask after NPPV, and 20 patients needed endotracheal intubation. Sixty-four percent of NPPs in 54 patients without apomorphic success. Conclusions NPPV is not a contraindication to COPD patients with severe respiratory failure and delirium.