无创通气联合体外膈肌起搏治疗慢性阻塞性肺疾病急性加重患者临床效果观察

Clinical observation of noninvasive ventilation combined with diaphragm pacing in treatment of patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨无创通气联合体外膈肌起搏治疗慢性阻塞性肺疾病(COPD)急性加重患者临床效果。方法选择该院2015-10~2016-10收治的COPD急性加重患者106例,按照随机数字表法分为观察组和对照组各53例。两组患者均采用常规治疗,对照组采用体外膈肌起搏治疗,观察组在对照组基础上结合无创通气治疗。两组疗程均为7 d。结果两组患者治疗后呼吸频率和心率均降低(P<0.05),观察组低于对照组(P<0.01);血氧分压(Pa O2)增加而二氧化碳分压(Pa CO2)降低(P<0.05),观察组Pa O2高于而Pa CO2低于对照组(P<0.01);第一秒呼出气量(FEV1)和第一秒呼出气量/用力肺活量(FEV1/FVC)增加(P<0.05),观察组FEV1和FEV1/FVC高于对照组(P<0.01);两组均无死亡患者。结论无创通气联合体外膈肌起搏治疗COPD急性加重患者效果明显,预后良好,具有重要研究意义。

Objective To investigate the clinical effect of noninvasive ventilation combined with diaphragm pacing on the patients with acute exacerbation of chronic obstructive pulmonary disease（ COPD）. Methods One hundred and six patients with acute exacerbation of COPD admitted to our hospital from October 2015 to October 2016 were randomly divided into the observation group（ n = 53） and the control group（ n = 53）. The patients in the two groups were treated with the same conventional therapy. Besides this,the control group received an additional treatment of diaphragm pacing,while the observation group received noninvasive ventilation plus the same additional treatment as the control group. The course of treatment in the two groups was 7 days. Results The respiratory rate and heart rate in the two groups were decreased after the treatment compared with those before the treatment（ P 0. 05）,while the improvement of the two rates in the observation group were lower than those in the control group（ P 0. 01）; Pa O2 was increased and Pa CO2 was decreased in both of the two groups after treatment and Pa CO2 was lower in the observation group than those in the control group after treatment（ P 0. 01）. FEV1 and FEV1/FVC were increased in the two groups（ P 0. 05）,while the levels of FEV1 and FEV1/FVC in the observation group were higher than those in the control group（ P 0. 01）. There were no deaths in the two groups. Conclusion Noninvasive ventilation combined with diaphragm pacing has a significant effect and a good prognosis in the treatment of acute exacerbation of COPD.