无创通气用于慢性阻塞性肺疾病急性发作期伴呼吸衰竭患者临床研究

Non-invasive Ventilation for Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Respiratory Failure

目的研究无创通气用于慢性阻塞性肺疾病(COPD)急性发作期伴呼吸衰竭患者的临床效果。方法方便选取2016年1月—2017年12月该院收治的68例COPD急性发作期并伴呼吸衰竭的患者,有创通气组采用常规有创通气进行治疗,无创通气组采用无创通气治疗,对比上机前、上机30 min、上机2 d的血气变化,相关肺炎(VAP)的发生率及住院时间。结果有创通气30 min时PaO_2、PaCO_2、pH分别为(146.36±17.32)mmHg、(56.69±10.59)mmHg、(7.40±0.09),机械通气2 d时有创通气PaO_2、PaCO_2、pH分别为(86.43±9.13)mmHg、(57.43±5.29)mmHg、(7.39±0.50)。可见有创通气30 min时PaO_2的升高,PaCO_2的下降及pH的恢复明显快于无创通气组(t=14.94、15.48、22.19,P<0.05),2 d后则差异无统计学意义(t=5.35、1.64、2.43,P>0.05);无创通气组的VAP发生率为2.94%,有创通气组的VAP发生率为23.53%,无创通气组患者住院时间为(15.32±2.78)d,有创通气组患者住院时间为(18.01±2.90)d,比较组间数据差异有统计学意义(P<0.05)。结论无创通气治疗COPD急性发作合并呼吸衰竭疗效显著。

Objective To study the clinical effect of noninvasive ventilation in patients with chronic obstructive pulmonary disease （COPD） with acute respiratory failure. Methods From January 2016 to December 2017, 68 patients with acute COPD and respiratry failure were convenient selected in the hospital. The invasive ventilation group was treated with conventional invasive ventilation, and the non-invasive ventilation group was treated with noninvasive ventilation. Blood qi changes in front of the machine, on the machine for 30 minutes, on the machine 2 d, the incidence of related pneumonia （VAP） and hospitalization time were observed. Results PaO2, PaCO2 and pH were （146.36±17.32）mmHg, （56.69±10.59） mmHg, （7.40±0.09） at 30 min after invasive ventilation, invasive ventilation Pa02, PaC02 and pH were observed respectively after mechanical ventilation for 2 days. It was （86.43±9.13）mmHg, （57.43±5.29）mmHg, （7.39±0.50）. It can be seen that Pa02 increased at 30 rain after invasive ventilation, PaC02 decreased and pH recovery was significantly faster than non-invasive ventilation group （t=14.94, 15.48, 22.19,P〈0.05）, and there was no significant difference after 2 d （t=5.35, 1.64, 2.43,P〉 0.05）; the incidence of VAP was 2.94% in the invasive ventilation group, 23.53% in the non-invasive ventilation group, （15.32±2.78）d in the invasive ventilation group, and （18.01±2.90）d in the non-invasive ventilation group, the difference between the comparison groups was statistically significant （P〈0.05）. Conclusion Noninvasive ventilation is effective in the treatment of acute exacerbation of COPD with respiratory failure.