呼吸机双水平气道正压通气治疗重叠综合征合并呼吸衰竭的疗效评估

The observation on curative effect of BiPAP of ventilator in treating OS with respiratory failure

目的:评估呼吸机双水平气道正压通气(BiPAP)和持续气道正压通气(CPAP)在治疗重叠综合征(OS)合并呼吸衰竭的临床疗效及差异性。方法:选取在医院睡眠呼吸监测诊疗中心诊疗的120例OS患者,根据治疗中呼吸机通气方式不同将其分为观察组(70例)和对照组(50例)。观察组采用BiPAP联合常规药物治疗,对照组采用CPAP联合常规药物治疗。记录两组正压通气时间、转为气管插管通气的比率;观察比较两组治疗前后血气分析pH值、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO2)、血氧饱和度(SaO_2)指标、肺功能用力肺活量(FVC)、第1 s用力呼气容积(FEV1)和FEV1与FVC的比率(FEV1/FVC)指标,以及呼吸暂停低通气指数、总睡眠时间及最低氧饱和度的改善情况。结果:治疗后观察组转为气管插管通气治疗的患者5例(占7.1%),对照组10例(占20%),差异有统计学意义(x~2=4.408,P<0.05);观察组的呼吸机使用时间及住院时间均低于对照组,差异有统计学意义(t=7.328,t=3.168;P<0.05)。治疗后观察组总睡眠时间、最低氧饱和度及呼吸暂停低通气指数均明显优于对照组,差异有统计学意义(t=2.274,t=2.137,t=8.085;P<0.05);观察组的PaO_2及SaO_2高于对照组,PaCO2低于对照组,差异有统计学意义(t=2.676,t=1.998,t=2.215;P<0.05);两组FVC、FEV1及FEV1/FVC较治疗前均明显升高,观察组升高程度高于对照组,差异有统计学意义(t=3.918,t=2.339,t=2.196;P<0.05)。结论:OS合并呼吸衰竭患者,呼吸机BiPAP模式和CPAP模式均能较好的改善肺功能及夜间睡眠质量,提升肺通气相关指标,但BiPAP模式可缩短呼吸机使用时间,有助于血气分析及肺功能等指标的恢复。

Objective:To observe the difference s of clinically curative effect of bi-level positive airway pressure(BiPAP)and continuous positive airway pressure(CPAP)in treating overlap syndrome(OS)with respiratory failure.Methods:A total of 120 patients with OS accepted treatment in hospital were selected,and they were divided into observation group(70 cases)and control group(50 cases)according to the different ventilation mode of ventilator.The observation group(70 cases)adopted BiPAP combined with conventional medicine treatment,and the control group(50 cases)adopted CPAP combined with conventional medicine treatment.The duration of positive pressure ventilation and the ratio of“converted to tracheal intubation ventilation”in the all ventilation of the two groups were recorded and compared.A series of indicators of arterial blood gas analysis included pH value,arterial partial pressure of oxygen(PaO2),partial pressure of carbon dioxide in artery(PaCO2),oxyhemoglobin saturation(SaO2),forced vital capacity(FVC)of pulmonary function,forced expiratory volume at the 1th second(FEV1),the ratio of FEV1 and FVC(FEV1/FVC),apnea hypopnea index(AHI),the total sleep time(TST)and the lowest arterial O2 saturation pre and post treatment between two groups were observed and compared.Results:Five cases(7.1%)converted to the treatment of tracheal intubation ventilation in observation group post treatment,and 10 cases converted to that in control group post treatment(x2=4.408,P<0.05).The ventilator use time and hospital stay in observation group were significantly lower than those in control group(t=7.328,t=3.168,P<0.05).After the treatment,the total sleep time,the lowest oxygen saturation and AHI in observation group were significantly better than those in control group(t=2.274,t=2.137,t=8.085,P<0.05).The PaO2 and SaO2 in observation group were significantly higher than those in control group,and PaCO2 of observation group was significantly lower than that of control group(t=2.676,t=1.998,t=2.215,P<0.05).Compared with the levels of FVC,FEV1,FEV1/FVC of two groups before treatment,those were increased significantly after treatment,and those of observation group were significantly higher than those of control group(t=3.918,t=2.339,t=2.196,P<0.05).Conclusion:For OS patients with respiratory failure,both BiPAP mode and CPAP mode can improve the lung function and sleep quality of patients at night,and enhance related indicators of pulmonary ventilation.But BiPAP mode can shorten the use time of ventilator and contribute to blood gas analysis and the recovery of lung function indicators.