双水平气道正压通气呼吸机无创通气和鼻导管低流量吸氧治疗老年慢性阻塞性肺疾病并呼吸衰竭的效果比较

Effect comparison of non-invasive ventilation with Bi-level positive airway pressure ventilator and low-flow oxygen by nasal cannula in the treatment of elderly patients with chronic obstructive pulmonary disease and respiratory failure

目的探讨双水平气道正压通气(BiPAP)呼吸机无创通气和鼻导管低流量吸氧治疗老年慢性阻塞性肺疾病并呼吸衰竭的临床应用效果。方法选取我院2015年4月～2018年4月收治的100例老年慢性阻塞性肺疾病并呼吸衰竭患者作为研究对象,按照随机数字表法分为对照组和研究组,每组各50例。两组均给予基础治疗,对照组加以鼻导管低流量吸氧治疗,研究组加以BiPAP呼吸机无创通气治疗。比较两组患者的临床疗效、急性生理功能与慢性健康(APACHEⅡ)评分、动脉血氧分压(PaO_2)、pH值、动脉血二氧化碳分压(PaCO_2)、呼吸频率(HR)、心率(RR)以及并发症发生情况。结果研究组患者的临床总有效率(86.00%)高于对照组(64.00%),差异有统计学意义(P<0.05)。两组患者干预前的pH值、PaO_2、PaCO_2、HR、RR水平及APACHEⅡ评分比较,差异无统计学意义(P>0.05)。两组干预96 h的pH、PaO_2水平高于干预前,差异有统计学意义(P<0.05)。两组干预96 h时PaCO_2、HR、RR水平及APACHEⅡ评分低于干预前,差异有统计学意义(P<0.05)。研究组干预96 h的PaCO_2、HR、RR水平及APACHEⅡ评分低于对照组,差异有统计学意义(P<0.05)。研究组干预96 h的pH、PaO_2水平高于对照组,差异有统计学意义(P<0.05)。研究组的并发症总发生率(26.00%)高于对照组(4.00%),差异有统计学意义(P<0.05)。结论BiPAP呼吸机无创通气治疗老年慢性阻塞性肺疾病并呼吸衰竭效果确切,可显著改善患者临床症状及血气指标,但并发症发生率较高,临床应用中应注意并发症处理。

Objective To investigate the clinical application effect of non-invasive ventilation with Bi-level positive airway pressure (BiPAP) ventilator and nasal low-flow oxygen in the treatment of elderly patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods A total of 100 elderly patients with COPD and respiratory failure admitted to our hospital from April 2015 to April 2018 were enrolled as subjects. By a random number table method, all patients were divided into the study group and the control group, 50 cases in each groups. Both groups were provided with basic treatment. In the control group, low-flow oxygen via nasal catheter was added, while in the study group, non-invasive ventilation with BiPAP ventilator was added. The clinical efficacy, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, arterial oxygen partial pressure (PaO2), potential of hydrogen (pH), arterial blood carbon dioxide partial pressure (PaCO2), respiratory rate (RR), heart rate (HR), and the incidence rate of complications were compared between the two groups. Results The total clinical effectiveness rate was 86.00% in the study group, which was higher than that of the control group accounting for 64.00%, with significant difference (P<0.05). There were no significant differences in the levels of pH, PaO2, PaCO2, HR, RR and APACHE Ⅱ scores before intervention between the two groups (P>0.05). At 96 hours of intervention, the levels of pH and PaO2 between the two groups were higher than those before intervention, with significant differences (P<0.05). Meanwhile, the levels of PaCO2, HR, RR, and the APACHE Ⅱ scores of the two groups were lower than those before intervention, with statistical significance (P<0.05). After 96-hour intervention, the level of PaCO2, HR, RR and the APACHE Ⅱ score in the study group were lower than those in the control group, with statistical differences (P<0.05). The levels of pH and PaO2 in the study group were higher than those in the control group at 96-hour intervention, which differed statistically (P<0.05). The total incidence rate of complications in the study group was 26.00%, which was higher than that in the control group accounting for 4.00%, with significant difference (P<0.05). Conclusion Non-invasive ventilation with BiPAP ventilator can obtain a definite effect on treating elderly patients with COPD and respiratory failure by significantly improving the clinical symptoms and blood gas indicators, but the incidence rate of complications is high, which should be paid attention for its complication management in clinical application.