双水平无创正压通气联合布地奈德治疗慢性阻塞性肺疾病急性发作期伴Ⅱ型呼吸衰竭的研究

Effect of Bi-level Positive Airway Pressure Ventilator and Budesonide for COPD Patients Combined with Type Ⅱ Respiratory Failure

目的观察双水平气道正压通气(bi-level positive airway pressure,BiPAP)联合布地奈德雾化吸入治疗慢性阻塞性肺疾病急性发作期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)伴Ⅱ型呼吸衰竭的临床疗效。方法 90例AECOPD并发Ⅱ型呼吸衰竭的患者按照入院先后顺序随机均分为3组:常规治疗组、BiPAP组、BiPAP+布地奈德组。观察3组患者治疗前与治疗后12、24、48 h和72 h时后的血气分析、呼吸频率(respiratory rate,RR)和心律(heart rate,HR)的变化,治疗前以及治疗后72 h改良英国医学研究理事会呼吸困难指数(modified British medical research council,mMRC)和C反应蛋白(C-reactive protein,CRP)指标变化情况,统计住院时间以及改为有创通气的例数。结果 BiPAP组、BiPAP+布地奈德组治疗后12、24、48 h和72 h血气分析,RR、HR均优于常规治疗组(P<0.05)。BiPAP组和BiPAP+布地奈德组两组之间比较pH值和HR(治疗后12、24 h和48 h)、动脉血氧分压(arterial partial pressure of oxygen,PaO2)(治疗后12h和24h)、动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO2)(治疗后12 h)均有统计学意义(P<0.05)。以上两组在mMRC评分、CRP和住院时间上也均优于常规治疗组(P<0.05),且BiPAP+布地奈德组较BiPAP组症状改善更迅速,住院时间更短,差异具有统计学意义(P<0.05)。结论 BiPAP联合布地奈德雾化吸入治疗AECOPD伴Ⅱ型呼吸衰竭,能明显改善患者临床症状,缩短住院时间,有较好的临床应用价值。

Objective To study clinical influence of combination therapy of bi-level positive airway pressure（BiPAP）ventilation and inhaling budesonide for acute exacerbation of chronic obstructive pulmonary disease（AECOPD）patients with typeⅡ respiratory failure.Methods A total of 90 AECOPD patients with typeⅡ respiratory failure were randomly divided into 3 groups.Routine group（n=30）：patients were treated with basic treatment,BiPAP group（n=30）：patients were treated with basic treatment and BiPAP ventilation.BiPAP ＋ budesonide group（n=30）：patients were treated with combination therapy of BiPAP ventilation and inhaling budesonide.Results Compared with routine group,pH,arterial partial pressure of oxygen（PaO2）,arterial partial pressure of carbon dioxide（PaCO2）,respiratory rate（RR）and heart rate（HR）at 12 h,24h,48 h and 72 h of BiPAP ＋ budesonide group and BiPAP group had obviously improved（P〈0.05）.There were significantly different between BiPAP group and BiPAP ＋ budesonide group of pH and HR（12h,24 h and 48 h after treatment）,PaO2（12h and 24 h after treatment）,PaCO2（12h after treatment）（P〈0.05）.The hospital stays were shortest in BiPAP＋ budesonide group（P〈0.01）,C-reactive protein（CPR）and modified British medical research council（mMRC）scores were better than other groups（P〈0.05）.Conclusion The effect of combination therapy of BiPAP ventilation and inhaling budesonide for the AECOPD patients with type II respiratory failure is better than traditional treatment or BiPAP ventilation singly.The technique is worthy to promotion.