压力调节容量控制模式联合体外膈肌起搏对慢性阻塞性肺疾病急性加重期患者的疗效及安全性研究

The efficacy and safety of pressure-regulated volume control combined with external dia⁃phragm pacing in patients with acute exacerbation of chronic obstructive pulmonary disease

目的:探究压力调节容量控制模式(PRVC)联合体外膈肌起搏对慢性阻塞性肺疾病急性加重期(AECOPD)患者疗效及安全性。方法:选取2017年9月至2018年10月河北唐山开滦总医院收治的AECOPD患者118例,按随机数字表法分为对照组和观察组,每组59例。所有患者入院后均给予祛痰、抗感染、解痉平喘等常规治疗,对照组采用体外膈肌起搏治疗,观察组联合PRVC治疗。比较两组患者治疗前、后呼吸频率、心率(HR)、血气分析、肺功能及不良反应发生率。结果:治疗前两组呼吸频率、HR、血气分析、肺功能比较,差异均无统计学无意义(P>0.05);与治疗前比较,治疗后两组呼吸频率、HR、二氧化碳分压(PaCO2)均降低,氧分压(PaO2)、氧合指数(PaO2/FiO2)、第1秒用力呼气量(FEV1)、FEV1/用力肺活量(FVC)均升高,且观察组变化更为显著(均P<0.05)。观察组腹胀、气压伤、焦虑、误吸/漏气、排痰障碍的发生率均低于对照组(P<0.05)。结论:PRVC联合体外膈肌起搏治疗较单纯使用体外膈肌起搏治疗能够有效改善AECOPD患者的呼吸情况,改善血气分析及肺功能,且安全性较好。

Objective:To explore the efficacy and safety of pressure-regulated volume control(PRVC)combined with external diaphragmatic pacing in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 118 AECOPD patients treated in Kailuan General Hospital of Tangshan from September 2017 to October 2018 were selected and randomly divided into a control group and an observation group,with 59 cases in each group.All patients received expectorant,anti-infection,antispasmodic and antiasthmatic treatment after admission.The patients in the control group were treated with external diaphragm pacing,and those in the observation group were treated as the control group with addition of PRVC.The respiratory frequency,heart rate(HR),blood gas analysis,lung function,prognosis and adverse reactions were compared.Results:Before treatment,there was no significant difference in respiratory rate,HR,blood gas analysis,and lung function between the two groups(P>0.05).The respiratory rate,HR and partial pressure of carbon dioxide(Pa-CO2)were decreased,while the oxygen partial pressure(PaO2),oxygenation index(PaO2/FiO2),first second forced expiratory volume(FEV1),and FEV1/forced vital capacity(FVC)were increased after treatment in both groups,but the changes were more obvious in the observation group(P<0.05).The incidence of abdominal distension,barotrauma,anxiety,aspiration/leakage,and sputum discharge disorders in the observation group were lower than that in the control group(P<0.05).Conclusion:PRVC combined with extracorporeal diaphragm pacing therapy could effectively improve the respiration,the arterial blood gas and lung function of patients with AECOPD,and it was safe.