不同吸入氧浓度无创机械通气对老年慢性阻塞性肺疾病并Ⅱ型呼吸衰竭患者影响的对比研究

Comparative Study for Impact of Non-invasive Mechanical Ventilation with Different FiO_2 on Elderly COPD Patients Complicated with Type Ⅱ Respiratory Failure

目的比较不同吸入氧浓度无创机械通气对老年慢性阻塞性肺疾病(COPD)并Ⅱ型呼吸衰竭患者的影响。方法选取2013年5月—2016年5月上海华东医院急诊内科收治的老年COPD并Ⅱ型呼吸衰竭患者72例,采用随机数字表法分为A组、B组和C组,每组24例。3组患者均行常规药物治疗及无创机械通气治疗,其中A组患者吸入氧浓度为30%,B组患者吸入氧浓度为45%,C组患者吸入氧浓度为60%。比较3组患者治疗前1 d及治疗后1、5 d血气分析指标〔pH值、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(PaCO_2)〕及肾功能指标〔尿素氮(BUN)、血肌酐(Scr)、肾损伤分子1(KIM-1)〕。结果时间与方法在p H值、PaO_2、PaCO_2上存在交互作用(P<0.05);时间在p H值、Pa O2、PaCO_2上主效应显著(P<0.05);方法在p H值、PaO_2、PaCO_2上主效应显著(P<0.05);治疗后5 d B组患者p H值、PaO_2高于A组和C组,PaCO_2低于A组和C组(P<0.05)。时间与方法在BUN、Scr、KIM-1上存在交互作用(P<0.05);时间在BUN、Scr、KIM-1上主效应显著(P<0.05);方法在BUN、Scr、KIM-1上主效应显著(P<0.05);治疗后5 d B组患者BUN、Scr及KIM-1低于A组和C组(P<0.05)。结论与30%、60%吸入氧浓度相比,45%吸入氧浓度无创机械通气可更有效地改善老年COPD并Ⅱ型呼吸衰竭患者血气分析指标及肾功能。

Objective To compare the impact of non- invasive mechanical ventilation with different FiO2 on elderly COPD patients complicated with type Ⅱ respiratory failure. Methods From May 2013 to May 2016,a total of 72 elderly COPD patients complicated with type Ⅱ respiratory failure were selected in the Department of Emergency, Huadong Hospital of Shanghai,and they were divided into A group, B group and C group according to random number table, each of 24 cases. Patients of the three groups received conventional medical treatment and non- invasive mechanical ventilation,thereinto FiO2 of A group was 30%,of B was 45%,of C group was 60%. Blood- gas analysis results（ including p H,Pa O2 and PaCO2）and index of renal function（ including BUN,Scr and KIM-1） before 1 day of treatment,after 1 day and 5 days of treatment were compared among the three groups. Results There was interaction between time and method in p H,Pa O2 and PaCO2（ P 〈0. 05）,the main effects of time and method were significant in pH,PaO2 and PaCO2（ P 〈 0. 05）; after 5 days of treatment,p H and Pa O2 of B group were statistically significantly higher than those of A group and C group,while PaCO2 of B group was statistically significantly lower than that of A group and C group（ P 〈 0. 05）. There was interaction between time and method in BUN,Scr and KIM-1（ P 〈 0. 05）,the main effects of time and method were significant in BUN,Scr and KIM-1（ P 〈 0. 05）;after 5 days of treatment,BUN,Scr and KIM-1 of B group were statistically significantly lower than those of A group and C group（ P 〈 0. 05）. Conclusion Compared with 30% or 60% FiO2,non- invasive mechanical ventilation with 45% FiO2 can more effectively adjust the blood- gas analysis results and improve the renal function of elderly COPD patients complicated with type Ⅱrespiratory failure.