无创正压通气串联雾化吸入治疗对AECOPD合并2型呼吸衰竭患者的疗效分析

Analysis of Curative Effect of Noninvasive Positive Pressure Ventilation Atomizing Inhalation in Treatment of Patients with AECOPD and Type 2 Respiratory Failure

目的探讨在无创正压通气管路中串联雾化吸入装置对AECOPD合并2型呼吸衰竭患者的临床疗效。方法采用前瞻性,随机(随机数字表法),对照设计,将2014年6月—2016年6月在该科住院的68例AECOPD合并2型呼吸衰竭患者随机分为A、B两组,A组34例,B组34例,A组采用无创正压通气串联雾化吸入布地奈德、特布它林治疗,B组中心管道氧气喷射雾化治疗。分别记录治疗前及治疗72 h后患者动脉血气分析及CRP、TNFα的变化。结果治疗组显效率为82.35%,对照组显效率为58.82%,治疗组明显优于对照组,差异有统计学意义(P<0.05);治疗72 h后,治疗组p H、PaO_2/FiO_2、PaCO_2分别为(7.39±0.04)、(266.00±32.20)mm Hg、(46.05±6.11)mm Hg,较治疗前显著改善,差异有统计学意义(P<0.05),与对照组相比,明显优于对照组,差异有统计学意义(P<0.05);且治疗后治疗组CRP、TNFα分别为(37.53±10.95)mg/L、(29.03±9.69)μg/L,水平下降较B组更为显著,差异有统计学意义(P<0.05)。结论与口含式喷射雾化相比,串联在无创通气中的雾化治疗对AECOPD合并2型呼吸衰竭血气分析改善,炎症因子降低更为显著。

Objective To study the clinical curative effect of noninvasive positive pressure ventilation atomizing inhala- tion in treatment of patients with AECOPD and type 2 respiratory failure. Methods 68 cases of patients with AECOPD and type 2 respiratory failure treated in our department from June 2014 to June 2016 were randomly selected and di- vided into two groups with 34 cases in each, the group A adopted the noninvasive positive pressure ventilation atomiz- ing inhalation treatment of budesonide and terbutaline, while the group B adopted the hub pipeline spray atomization, and the arterial blood gas analysis and changes of CRP and TNFctbefore treatment and in 72h after treatment were re- spectively recorded. Results The markedly effective rate in the treatment group was obviously better than that in the control group（82.35% vs 58.82%）, and the difference was statistically significant（P〈0.05）, in 72 h after treatment, the pH, PaO2/FiO2 and PaCO2 in the treatment group were respectively （7.39±0.04）, （266.00±32.20）mmHg, （46.05±6.11 ） mmHg, which were obviously improved compared with those before treatment, and the differences were statistically sig- nificant（P〈0.05）, after treatment, the CRP and TNFα in the treatment group were respectively（37.53±10.95） mg/L and （29.03±9.69） μg/L, and the decrease was more obvious than that in the group B, and the difference was statistically significant （P〈0.05）. Conclusion The improvement of noninvasive positive pressure ventilation atomizing inhalation intreatment of patients with AECOPD and type 2 respira- tory failure is more obvious than that of lip jet atomiza- tion and the decrease of inflammatory factors is more ob- vious.