昼夜使用BIPAP治疗慢性阻塞性肺疾病的效果对比

Comparison of the application effect of BIPAP at daytime and nighttime in the treatment of chronic obstructive pulmonary diseases

目的比较昼夜使用BIPAP治疗慢性阻塞性肺疾病(COPD)的效果。方法随机选取2014年7月~2016年5月我院收治的50例COPD急性发作患者作为研究对象,根据无创辅助通气时间分为日间组(33例)和夜间组(17例)。比较两组治疗前和治疗后2 h的动脉血气分析数据(PaCO_2、PaO_2、pH)、呼气峰值流速(PEF)、氧合指数、呼吸频率、心率、血压。结果两组治疗后的PEF水平高于治疗前,PCO_2水平低于治疗前,差异有统计学意义(P<0.01)。夜间组治疗后的PO_2水平显著高于治疗前,日间组治疗后的pH值显著高于治疗前,差异有统计学意义(P<0.01)。两组治疗前与治疗2 h后的氧合指数、呼吸频率、心率、血压比较,差异无统计学意义(P>0.05)。与夜间组相比,日间组PCO_2降低更明显;与日间组比较,夜间组PO_2升高更明显,差异有统计学意义(P<0.01)。结论不同时段无创辅助通气治疗对COPD急性发作患者的效果不同,临床医生可根据患者情况选择不同的时段进行无创辅助通气治疗。

Objective To compare the effect of biphasic intermittent positive airway pressure（BIPAP） at daytime and nighttime in the treatment of chronic obstructive pulmonary diseases（COPD）.Methods Altogether 50 cases of acute exacerbation of COPD who were treated in our hospital from July 2014 to May 2016 were randomly selected as the object of this research,and were divided into the daytime group（n=33） and the nighttime group（n=17） according to the time of noninvasive assisted ventilation.The arterial blood gas analysis data（PaCOP〈02,PaOP〈02,PH）,peak expiratory flow（PEF）,oxygenation index（OI）,respiratory rate（RR）,heart rate（HR）,blood pressure of the two groups at pre- and post-treatment 2 hours were compared.Results The level of PEF in the two groups after treatment was higher than that before treatment,and the level of PCOP〈02 in the two groups after treatment was lower than that before treatment,with significant difference（P0.01）.The level of POP〈02 in the nighttime group after treatment was higher than that before treatment,and the pH value of the daytime group after treatment was higher than that before treatment,with significant difference（P0.01）.There was no significant difference between the level of OI,RR,HR and blood pressure of the two groups before and two hours after treatment（P0.05）.Compared with the nighttime group,the level of PCOP〈02 in the daytime group decreased more significantly;compared with the daytime group,the level of POP〈02 in the nighttime group increased significantly,with significant difference（P0.01）.Conclusion Noninvasive assisted ventilation in different time of the day plays different effect on patients with AECOPD.Clinicians can carry out noninvasive assisted ventilation in different time of the day according to the patient′s conditions.