MICU中AECOPD患者由医院转换为家庭无创机械通气的实施观察

Observation of home non-invasive mechanical ventilation on AECOPD patients in MICU

目的观察慢性阻塞性肺病急性发作(AECOPD)患者由医院转换为家庭无创机械通气实施的效果。方法选取2011年1月至2013年12月期间住我科MICU采用无创机械通气(Non-Invasive Positive Pressure Ventilation,NIPPV)治疗的存在中度呼吸性酸中毒(7.25<pH<7.35)的AECOPD患者43例。根据病人出院后是否按出院医嘱进行了长期家庭无创通气(HMV)将病人分为HMV治疗组(22例)和对照组(21例),。应用Philips V60无创呼吸机,根据血气分析及病情调整参数,通气时间每日>15 h。观察NIPPV治疗前、治疗后6个月的肺功能、呼吸困难评分(mMRC)、SGRQ量表及血气分析,酶联免疫吸附法检测外周血细胞因子IL-17、MMP-9、TNF-R75。结果 HMV治疗组6个月时与对照组比较PaO2、PaCO2、mMRC、SGRQ评分、FEV1%pro及FEV1/FVC明显改善(P<0.05),同时,外周血细胞因子IL-17、MMP-9、TNF-R75亦较对照组有明显改善(P<0.05)。结论 HMV对MICU中存在中度呼吸性酸中毒的AECOPD患者可以安全实现从医院过渡到家庭NIPPV治疗,有效延长COPD的稳定期、提高患者生活质量。

Objective To observe the effect of home non-invasive mechanical ventilation（ HNIMV） on patients with AECOPD in MICU. Methods 43 AECOPD patients with moderate respiratory acidosis（ 7. 25 pH 7. 35） were treated with non-invasive positive pressure ventilation（ NIPPV） in MICU at first,and then they were divided into two groups： the HNIMV group（ n = 22） with home NIPPV therapy and the control group（ n = 21） without HMV therapy. Their lung function,dyspnea scores,SGRQ,arterial blood gas were observed,and their serum levels of IL-17,MMP-9 and TNF-R75 were measured by ELISA. Results Six months after the treatment,the improvement of mMRC and SGRQ scores,FEV1/FVC,arterial PaCO2 and PaO2and the serum levels of IL-17,MMP-9 and TNFR75 was more pronounced in the HNIMV group than in the control group（ P〈0. 05）. Conclusion HNIMV therapy can effectively and safely achieve the transition of AECOPD patients with moderate respiratory acidosis from MICU to home NIPPV treatment,which can prolong the COPD stabilization and improve their life quality.