防误吸干预在慢性阻塞性肺疾病急性加重期无创通气患者中的应用效果

The effect of anti-aspiration intervention on acute exacerbation of chronic obstructive pulmonary disease patients with non-invasive ventilation

目的探讨防误吸干预在慢性阻塞性肺疾病急性加重期(AECOPD)无创通气(NIV)患者中的应用效果。方法选取2016年4月~2018年4月我院呼吸内科住院的60例AECOPD具有NIV指征患者,按入院顺序分为治疗组和对照组,每组各30例。对照组予常规治疗及无创双水平正压通气治疗。治疗组在对照组基础上采取防误吸干预措施:(1)半坐位通气、进食;(2)防胃食管返流;(3)口腔护理;(4)低头吞咽;(5)吞咽流质时使用凝固粉。疗程10 d。观察两组临床效果、慢阻肺自我评估问卷(CAT)评分、动脉血气分析指标[氧分压(PaO_2)、二氧化碳分压(PaCO_2)]及住院时间。结果治疗组临床效果优于对照组(P<0.05);治疗组治疗后CAT评分低于对照组(P<0.01),PaO_2高于对照组(P<0.01),而PaCO_2低于对照组(P<0.01);治疗组住院时间短于对照组,差异均有统计学意义(P<0.05)。结论防误吸干预能提高AECOPD患者NIV的效果,改善AECOPD症状及血气分析指标,缩短住院时间,值得临床推广应用。

Objective To observe the effect of anti-aspiration intervention on acute exacerbation of chronic obstructive pulmonary disease(AECOPD) patients with non-invasive ventilation(NIV). Methods From April 2016 to April 2018,60 AECOPD in-patients with NIV were selected and divided into treatment group and control group by in hospital order, 30 cases in each group. The control group was received conventional treatment and NIV with BIBP model. On the basis of the control group, the treatment group was adopted the preventive measures of anti-aspiration:(1)half sitting while ventilating and eating;(2) anti-GRED;(3) oral nursing;(4) lowering head while swallowing;(5) using solidifying powder while swallowing liquid. The course of treatment was 10 days. The clinical effect, CAT score, arterial blood gas analysis(PaO2, PaCO2)and the hospitalization time were observed. Results After the treatment, the clinical effects of the treatment group were better than those of the control group(P<0.05). The treatment group′s CAT score was lower than that of the control group(P<0.01), while PaO2 was higher than that of the control group(P<0.01) and PaCO2 was lower than that of the control group(P<0.01), and hospitalization time was shorter than that of the control group, the differences were statistically significant(P<0.05). Conclusion Anti-aspiration intervention can improve the clinical effect of AECOPD patients with NIV, it can improve AECOPD symptoms and arterial blood gas analysis index and shorten hospitalization time. It is worthy of clinical reference.