限制性液体管理在COPDⅡ型呼吸衰竭中的应用

Application of restrictive fluid management in COPD complicating respiratory failureⅡ

目的探讨限制性液体管理在慢性阻塞性肺疾病(COPD)Ⅱ型呼吸衰竭中的应用效果。方法选择2012年7月至2014年1月佛山市南海区第二人民医院收治的70例COPDⅡ型呼吸衰竭的患者进行研究。按照随机数表法将70例患者随机均分为观察组和对照组,每组各35例。根据患者CVP(中心静脉压)及出入量情况进行液体的管理。观察组采用限制性的液体管理措施,对照组采用非限制性的液体管理措施。监测分析两组患者液体管理前后的乳酸、N末端B型利钠肽原(NT-pro BNP)及氧合指数,并调查记录两组患者机械通气时间。结果液体管理前,两组患者的CVP、乳酸、NT-pro BNP及氧合指数差异均无统计学意义(P>0.05);液体管理后,观察组的氧合指数、NT-pro BNP改善状况明显优于对照组(P<0.01)。液体管理后,观察组患者机械通气时间平均为(10.23±3.02)d,对照组患者为(12.04±2.88)d,其差异有统计学意义(P<0.05)。结论限制性液体管理在COPDⅡ型呼吸衰竭中的应用价值较高,值得临床推广应用。

Objective To study the effect of restrictive fluid management in chronic obstructive pulmonary disease（COPD） complicating respiratory failure Ⅱ. Methods Seventy COPD patients with respiratory failure from July 2012 to January 2014 in the Second People＇s Hospital of Nanhai District of Foshan City were randomly assigned to the experimental group and the control group. Regulated by central venous pressure and the input and output volume, the experimental group received restrictive fluid management, while the control group received non-restrictive fluid management. The level of lactate acid, NT-pro BNP, oxygenation index and time of mechanical ventilation were compared between the two groups before and after fluid management. Results The level of lactate acid, NT-pro BNP,oxygenation index and time of mechanical ventilation before fluid management showed no statistically significant difference between the two groups（P〈0.05）. After restrictive fluid management, the improvements in oxygenation index and NT-pro BNP in experimental group were significantly better than the control group（P〈0.01）. The average duration of mechanical ventilation was（10.23±3.02） d in experimental group and（12.04±2.88） d in the control group, with significant difference between the two groups（t=2.566 0, P=0.012 5）. Conclusion Mestrictive fluid management has better application value for treating COPD complicating respiratory failure.