高频胸壁震荡在慢性阻塞性肺疾病急性加重期有创通气患者治疗中的作用

A study of the value of high frequency chest wall oscillation in patients with acute exacerbation of chronic obstructive pulmonary disease

目的 探索高频胸壁震荡（HFCWO）对慢性阻塞性肺疾病（简称慢阻肺）急性加重患者行有创机械通气的安全性和有效性.方法 采用前瞻性随机对照研究,选取2012年2月至2013年2月四川大学华西医院重症医学科行有创机械通气的慢阻肺急性加重患者35例,利用SAS 9.1软件将患者完全随机分为对照组和高频胸壁震荡组（H组）.对照组接受常规治疗,H组接受HFCWO＋常规治疗.比较两组患者有创机械通气时间、无创通气时间、总机械通气时间、ICU留驻时间、住院时间及前7d的pH值和氧合指数,同时记录H组使用HFCWO前、中、后的心率、血压、呼吸、氧饱和度和气道峰压和呼吸机报警情况.结果 H组总机械通气时间为（10±6）d,低于对照组的（15±8）d（P＜0.05）,但两组有创机械通气时间、无创通气时间、ICU留驻时间、住院时间差异均无统计学意义（均P ＞0.05）,前7d的pH值和氧合指数差异均无统计学意义（均P＞0.05）.H组患者使用HFCWO前、中、后的心率、呼吸、血压、氧饱和度、气道峰压等无明显改变（均P＞0.05）.3.67％（8/281）人次出现严重呼吸机报警（3级）,且与机械通气时间和预后无明显相关性.结论 高频胸壁震荡在慢阻肺急性加重机械通气患者中应用具有较好的安全性和舒适性,可以减少总机械通气时间,但不能改善患者预后.

Objective To explore the safety and efficacy of high-frequency chest wall oscillation （HFCWO） in invasive mechanical ventilation patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）.Methods A prospective,randomized,controlled trial was conducted.Thirty-five AECOPD patients with invasive mechanical ventilation were included in the intensive care unit of West China Hospital of Sichuan University from February 2012 to February 2013.The patients were randomly allocated into a HFCWO （H） group and a control group using SAS 9.1 software.The control group received routine therapy,while the H group received HFCWO,along with routine therapy.Invasive mechanical ventilation time,noninvasive ventilation time,total mechanical ventilation time,ICU stay time,hospital stay time and pH,oxygen index （OI） during the first 7 days were collected.At the same time,heart rate,blood pressure,respiratory rate,SpO2 and peak airway pressure before,during and after HFCWO and ventilation alarm of the H group were collected.Results The total mechanical ventilation time of patients in the H group was significantly shorter than that of the control group [（10 ± 6） d and （15 ± 8） d,P ＜ 0.05].But there were no significant differences between the 2 groups in invasive mechanical ventilation time,noninvasive ventilation time,ICU stay and hospital stay time （P ＞ 0.05）.There were no significant differences between the 2 groups in pH and oxygen index during the first 7 days （P ＞ 0.05）.There were no change in heart rate,blood pressure,respiratory rate,SpO2 and peak airway pressure before,during and after HFCWO in the H group （P ＞ 0.05）.Severe ventilator alarm （level 3） occurred in 3.67％ patients,but there was no significant correlation between ventilation alarm and patient prognosis.Conclusions HFCWO is very safe and comfortable in ventilated patients with AECOPD.It reduces the total mechanical ventilation time,but cannot improve the prognosis.