COPD合并呼吸衰竭患者应用2种无创通气模式的疗效观察

Effects of Two Noninvasive Ventilation Therapies on Chronic Obstructive Pulmonary Disease Patients with Respiratory Failure

目的评价2种无创通气模式治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并呼吸衰竭患者的效果。方法将80例COPD并呼吸衰竭患者随机分为观察组和对照组各40例。观察组以平均容积保证压力支持(average volume assured pressure support,AVAPS)模式通气治疗,对照组采用自主触发/时间模式(S/T)通气治疗。两组患者在无创通气过程中,均采用护理干预措施以提高患者依从性,减少不良反应。比较两组患者治疗3 d后的动脉血酸碱度(PH)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血氧饱和度(SaO2)指标。观察比较两组患者上机后达到人机协调所用时间和治疗3 d内发生不良反应(胸闷憋气感、人机对抗、腹胀)和上机失败的情况。结果无创通气治疗3 d后,两组患者PaCO2下降,PaO2、SaO2上升,PH值改善,差异无统计学意义(P>0.05)。观察组在达到人机协调的时间较对照组短,胸闷憋气感、人机对抗和腹胀等不良反应发生较对照组低,两组比较差异具有统计学意义(P<0.01)。结论应用AVAPS模式通气治疗COPD合并呼吸衰竭安全有效,患者依从性较好,值得临床推广。

Objective To evaluate the effects of two models of noninvasive ventilation therapy on chronic obstructive pulmonary disease （COPD） patients with respiratory failure. Methods Eighty COPD patients with respiratory failure were randomly divided into observation group and control group, with 40 cases in each group. Patients in observation group were treated by average volume assured pressure support （AVAPS） model of noninvasive ventilation, but those in control group by self trigger/time （S/T） model of noninvasive ventilation. Nursing intervention measures were used to reduce adverse reaction during the ventilation and pH, PaO2, PaCO2, adverse reaction 3d after the treatment were compared. Results Patients in two groups showed a significant improvement in pH, PaO2, PaCO2 three days after treatment,but there was no statistically significant difference of intergroup comparison （P〉0.05）. There was shorter time of man-machine coordination in observation group, and lower incidence of chest tightness of breath, manmachine confrontation and abdominal distension, which showed statistical difference （P〈0.01）. Conclusion AVAPS model is safe and effective for COPD patients with respiratory failure and it is worth to be popularized.