轻度镇静联合无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的疗效

Efficacy of Mild Sedation combined with Non-invasive Positive Pressure Ventilation in Chronic Exacerbation of Respiratory Failure in Patients with Chronic Obstructive Pulmonary Disease

目的探讨轻度镇静联合无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的疗效。方法选取我院(2017年1月至2019年1月)收治的90例AECOPD呼吸衰竭患者,均经临床检查确诊,根据不同治疗分为两组,对照组(n=45)接受NIPPV治疗,观察组(n=45)在对照组基础上接受轻度镇静治疗,两组患者均先接受常规解痉、祛痰、抗感染、纠正电解质紊乱等治疗,再接受NIPPV治疗,观察组再接受轻度镇静治疗,对比两组患者治疗相关指标(住ICU时间、住院时间、气管插管率)和治疗前后血气指标、生命体征[PaCO2、PaO2、动脉血氧饱和度(SaO2)、舒张压(DBP)、SBP、R、pH、心率(HR)]以及病死率。结果观察组患者住ICU时间、住院时间分别为(7.42±2.14)d、(14.24±4.25)d,明显短于对照组(12.24±2.47)d、(17.54±4.17)d,有统计学差异(t=9.8937、3.7179)。气管插管率24.44%(11/45)明显低于对照组73.33%(33/45)(χ^2=17.8284,P<0.05)。治疗后观察组患者PaCO2、PaO2、SaO2、DBP、SBP、R、pH、HR分别为(42.51±2.14)mm Hg、(86.21±5.44)mm Hg、(96.32±6.52)%、(82.14±6.17)mm Hg、(128.42±9.36)mm Hg、(18.71±1.62)次/min、(7.40±0.04)、(112.32±8.36)次/min。对照组分别为(55.24±2.41)mm Hg、(72.51±5.36)mm Hg、(85.24±6.47)%、(84.74±6.32)mm Hg、(131.74±9.12)mm Hg、(23.25±1.72)次/min、(7.32±0.04)、(120.54±8.47)次/min。治疗后两组患者PaCO2、PaO2、SaO2、DBP、SBP、R、pH、HR均明显改善,观察组患者改善更明显(t=26.4957、12.0339、5.9009、1.9747、1.7042、12.8895、2.156、4.6334,P<0.05)。观察组患者1、3个月病死率分别为4(8.89%)、7(15.56%),明显低于对照组11(24.44%)、16(35.56%),均有统计学差异(χ^2=8.7056、10.5115,P<0.05)。结论轻度镇静联合无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的临床疗效满意,值得临床推广应用。

Objective To explore the efficacy of mild sedation combined with non-invasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease with acute exacerbation of respiratory failure.Methods 90 patients with AECOPD respiratory failure who were admitted to our hospital(January 2017-January 2019)were diagnosed by clinical examination and divided into two groups according to different treatments.The control group(n=45)received NIPPV treatment.The observation group(n=45)received mild sedation on the basis of the control group.The patients in both groups received conventional antispasmodic,expectorant,anti-infective,and correction of electrolyte disorders,and then received NIPPV treatment.The observation group received mild sedation.Degree sedation,comparing treatment-related indicators(time to live in ICU,length of hospital stay,tracheal intubation rate),blood gas indicators,vital signs before and after treatment[PaCO2,PaO2,arterial oxygen saturation(SaO2),and diastolic blood pressure(DBP),SBP,R,pH,heart rate(HR)]and mortality.Results The time of ICU stay and hospital stay in the observation group were(7.42±2.14)d and(14.24±4.25)d,which were significantly shorter than those in the control group of(12.24±2.47)d and(17.54±4.17)d,with statistical differences(t=9.8937,3.7179).The tracheal intubation rate of 24.44%(11/45)was significantly lower than the control group of 73.33%(33/45)(χ^2=17.8284,P<0.05).After treatment,the patients in the observation group were PaCO2,PaO2,SaO2,DBP,SBP,R,pH,and HR were(42.51±2.14)mm Hg,(86.21±5.44)mm Hg,(96.32±6.52)%,(82.14±6.17)mm Hg,(128.42±9.36)mm Hg,(18.71±1.62)times/min,(7.40±0.04),(112.32±8.36)times/min.The control group were(55.24±2.41)mm Hg,(72.51±5.36)mm Hg,(85.24±6.47)%,(84.74±6.32)mm Hg,(131.74±9.12)mm Hg,(23.25±1.72)times/min,(7.32±0.04),(120.54±8.47)times/min.After treatment,PaCO2,PaO2,SaO2,DBP,SBP,R,pH,and HR were significantly improved in the two groups,and the improvement in the observation group was more significant(t=26.4957,12.0339,5.9009,1.9747,1.7042,12.8895,2.156,4.6334,P<0.05).The mortality of patients in the observation group at 1 and 3 months was 4(8.89%)and 7(15.56%),which were significantly lower than those in the control group 11(24.44%)and 16(35.56%),which were statistically different(χ^2=8.7056,10.5115,P<0.05).Conclusion The clinical efficacy of mild sedation combined with non-invasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease with acute exacerbation of respiratory failure is satisfactory and worthy of clinical application.