无创呼吸机联合沙美特罗替卡松粉吸入剂在老年AECOPD患者中的应用

Application of noninvasive ventilator combined with salmeterol fluticasone powder inhalation in the treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease.

目的研究老年慢性阻塞性肺疾病急性加重期(AECOPD)应用无创呼吸机联合沙美特罗替卡松粉吸入剂治疗对患者肺功能改善及预后的影响。方法选择2016年1月至2019年3月新会区中医院葵湖院区收治的150例老年AECOPD患者作为研究对象,按照随机数表法将患者分为观察组和对照组各75例。两组患者均给予祛痰、解痉、预防感染、保持水电解质平衡等常规治疗,对照组在常规治疗基础上联合沙美特罗替卡松粉吸入剂治疗,观察组在对照组治疗的基础上联合无创呼吸机治疗,均连续治疗14 d。比较两组患者治疗14 d后的临床疗效、血气分析指标、肺功能和预后情况。结果治疗后,观察组患者的临床疗效总有效率为90.67%,明显高于对照组的76.00%,差异有统计学意义(P<0.05);观察组患者的动脉氧分压(PaO2)、脉搏血氧饱和度(SpO2)分别为(75.64±4.88)mmHg、(93.32±1.48)%,明显高于对照组的(68.20±4.32)mmHg、(90.74±1.72)%,动脉二氧化碳(PaCO2)为(41.26±3.04)mmHg,明显低于对照组的(47.57±3.52)mmHg,差异均有统计学意义(P<0.05);观察组患者第一秒最大呼气容积(FEV1)、FEV1/用力肺活量比值(FEV1/FVC)分别为(1.25±0.12)L、(61.21±2.71)%,明显高于对照组的(1.14±0.11)L、(57.87±2.05)%,差异均有统计学意义(P<0.05);观察组患者的住院时间为(14.04±2.51)d,明显短于对照组的(18.27±2.28)d,气管插管率、病死率、6个月再入院率分别为2.67%、1.33%、4.00%,明显低于对照组的12.00%、9.33%、13.33%,差异均有统计学意义(P<0.05)。结论老年AECOPD应用无创呼吸机联合沙美特罗替卡松粉吸入剂治疗可明显改善患者的肺功能及血气指标,并缩短住院时间,减少气管插管率、病死率及再入院率,改善预后,临床治疗效果显著,值得推广应用。

Objective To study the effect of noninvasive ventilator combined with salmeterol fluticasone powder inhalation on the pulmonary function improvement and prognosis in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 150 elderly patients with AECOPD who received therapy from January 2016 to March 2019 in Kuihu Branch,Xinhui District Hospital of Traditional Chinese Medicine were selected as research objects.They were divided into the observation group and the control group by random number table,with 75 patients in each group.The two groups of patients were given expectoration,spasmodic,infection prevention,water electrolyte balance treatment.The control group was treated with salmeterol fluticasone powder inhalation on the basis of routine treatment,and the observation group was treated with noninvasive ventilator combined with salmeterol fluticasone powder inhalation on the basis of routine treatment,continuously for 14 days.The clinical effect,blood gas analysis index,lung function,and prognosis in two groups were compared 14 days after treatment.Results After treatment,the total effective rate in the observation group was 90.67%,which was significantly higher than 76.00%in the control group(P<0.05);the arterial oxygen partial pressure(PaO2)and pulse oxygen saturation(SpO2)in the observation group were(75.64±4.88)mmHg,(93.32±1.48)%,respectively,which were significantly higher than(68.20±4.32)mmHg,(90.74±1.72)%in the control group,respectively,and the arterial carbon dioxide(PaCO2)in the observation group was(41.26±3.04)mmHg,which was significantly lower than(47.57±3.52)mmHg in the control group,all with statistically significant differences(P<0.05);the first second maximal expiratory volume(FEV1)and FEV1/forced vital capacity ratio(FEV1/FVC)in the observation group were(1.25±0.12)L,(61.21±2.71)%,respectively,which were significantly higher than(1.14±0.11)L,(57.87±2.05)%in the control group(P<0.05);the hospitalization time in the observation group was(14.04±2.51)d,which was significantly shorter than(18.27±2.28)d in the control group,and the intubation rate,mortality rate,and 6-month readmission rate were 2.67%,1.33%,and 4.00%respectively,which were significantly lower than 12.00%,9.33%,and 13.33%in the control group(P<0.05).Conclusion The application of noninvasive ventilator combined with salmeterol fluticasone powder inhalation in the treatment of elderly AECOPD can significantly improve the pulmonary function and blood gas index of patients,and shorten the hospitalization time,reduce the tracheal intubation,mortality and readmission rate,improve the prognosis,with remarkable clinical treatment effect,which is worthy of popularization and application.