俯卧位通气联合常规疗法治疗慢性阻塞性肺疾病急性加重期的临床应用价值

Clinical value of prone position ventilation combined with conventional therapy in treatment of acute exacerbation of chronic obstructive pulmonary disease

目的探讨俯卧位通气联合常规疗法治疗慢性阻塞性肺疾病急性加重期(AECOPD)行有创机械通气患者的临床应用价值。方法选择2013年1月至2014年1月收治的行有创通气的AECOPD患者60例,随机分为观察组和对照组,每组各30例。对照组患者给予常规疗法,观察组在常规疗法基础上,给予俯卧位通气,白天进行俯卧位通气6 h(其余时间为仰卧位通气),连续7 d。比较两组患者治疗后的动脉氧分压(Pa O2)、氧合指数(Pa O2\Fi O2)及临床疗效。结果 (1)两组患者治疗后第1 d、第3 d、第5 d及第7 d的Pa O2相比较,差异无统计学意义(P均>0.05);观察组患者治疗后第3 d、第5 d及第7 d的Pa O2/Fi O2明显高于对照组,差异有统计学意义(P均<0.05)。(2)观察组治疗总有效率(86.6%)稍高于对照组(80.0%),但差异无统计学意义(P>0.05)。结论对AECOPD患者实施俯卧位通气联合常规疗法,可明显提高患者的氧合指标,并有提高AECOPD患者临床疗效的趋势,但尚需进行大样本研究证实。

Objective To investigate the clinical efficacy of prone position ventilation combined with conventional therapy in the patients with acute exacerbation of chronic obstructive pulmonary disease（ AECOPD） received invasive mechanical ventilation. Methods A total 60 patients with AECOPD received invasive mechanical ventilation admitted from January2013 to January 2014 were selected,and the patients were randomly divided into observation group and control group（ n =30 each）. The conventional therapy was given in control group,and prone position ventilation（ 6 hours in the day for seven consecutive days） was given on the basis of conventional therapy in observation group. The oxygen partial pressure of arterial blood（ Pa O2）,oxygenation index（ Pa O2／ Fi O2） and clinical efficacy in two groups were compared. Results There were no significant differences in Pa O2 at 1-,3-,5-,7-day after treatment between two groups（ all P〈0. 05）. The Pa O2/ Fi O2 at 3-5-,7-day after treatment were significantly higher than those in control group（ all P〈0. 05）. The clinical total effective rate in observation group increased slightly compared with control group,but there was no statistical significance（ 86. 6% vs 80. 0%,P〉0. 05）. Conclusions The prone position ventilation combined with conventional therapy can improve oxygenation index in patients with AECOPD and has a trend of increasing clinical efficacy,but it needs to be researched with large sample size.