无创机械通气联合沙丁胺醇雾化吸入对老年COPD患者氧代谢、肺功能及血气指标的影响

Effect of non-invasive mechanical ventilation combined with salbutamol aerosol inhalation on oxygen metabolism,pulmonary function,and blood gas indexes in elderly patients with chronic obstructive pulmonary disease

目的探讨无创机械通气联合沙丁胺醇雾化吸入对老年慢性阻塞性肺病(COPD)患者氧代谢、肺功能及血气指标的影响。方法将延安市中医医院和中航工业西安医院2019年1~12月收治的130例COPD患者采用随机数表法分为对照组和观察组,每组65例。入院后均给予基础治疗,对照组患者给予无创机械通气治疗,观察组患者联合沙丁胺醇雾化吸入治疗,两组患者连续治疗7 d,比较两组患者治疗前后的氧代谢、肺功能、血气指标及不良反应发生情况。结果治疗后,观察组患者的氧耗指数(DO_(2))和氧摄取率(O_(2)ER)分别为(672.32±57.12)mL·min^(-1)·m^(-2)、(32.16±4.28)%,明显高于对照组的(598.34±58.29)mL·min^(-1)·m^(-2)、(29.83±4.52)%,而血乳酸(LA)为(2.12±0.36)mmol/L,明显低于对照组的(3.27±0.78)mmol/L,差异均有统计学意义(P<0.05);治疗后,观察组患者的第一秒末用力呼气量(FEV1)、呼气流量峰值(PEF)分别为(1.95±0.34)L、(2.74±0.39)L/s,高于对照组的(1.56±0.32)L、(2.41±0.43)L/s,而气道阻力(Reff值)为(0.52±0.12)kPa·L^(-1)·s^(-1),明显低于对照组的(0.78±0.14)kPa·L^(-1)·s^(-1),差异均有统计学意义(P<0.05);治疗后,观察组患者的动脉血二氧化碳分压(PaCO_(2))为(42.37±4.32)mmHg,明显低于对照组的(49.18±4.17)mmHg,而动脉血氧分压(PaO_(2))和pH值分别为(85.29±9.32)mmHg、7.41±0.12,明显高于对照组的(73.18±8.46)mmHg、7.32±0.10,差异均有统计学意义(P<0.05);观察组和对照组患者治疗期间不良反应发生率分别为7.69%、6.15%,差异无统计学意义(P>0.05)。结论沙丁胺醇雾化吸入联合无创机械通气治疗老年COPD可提高患者的血气指标和氧代谢能力,改善患者的肺功能,临床治疗效果较好且安全性高。

Objective To investigate the effect of non-invasive mechanical ventilation combined with salbutamol aerosol inhalation on oxygen metabolism,pulmonary function,and blood gas indexes in elderly patients with chronic obstructive pulmonary disease(COPD).Methods A total of 130 patients with COPD admitted to Yan'an Hospital of Traditional Chinese Medicine and Xi'an Hospital of AVIC from January to December,2019 were divided into control group and observation group by random number table method,with 65 patients in each group.All patients were given basic treatment after admission.Patients in the control group were given non-invasive mechanical ventilation therapy,and patients in the observation group were given additionally salbutamol aerosol inhalation therapy on this basis,both for 7 d continuously.Oxygen metabolism,pulmonary function,blood gas indexes,and the incidence of adverse reactions were compared between the two groups.Results After treatment,oxygen consumption index(DO_(2))and oxygen uptake rate(O_(2)ER)in the observation group were(672.32±57.12)mL·min^(-1)·m^(-2) and(32.16±4.28)%,significantly higher than(598.34±58.29)mL·min^(-1)×m^(-2) and(29.83±4.52)%in the control group;the level of blood lactic acid(LA)was(2.12±0.36)mmol/L,significantly lower than(3.27±0.78)mmol/L in the control group(P<0.05);the differences were statistically significant(P<0.05).After treatment,forced expiratory volume in 1 s(FEV1)and peak expiratory flow(PEF)in the observation group were(1.95±0.34)L and(2.74±0.39)L/s,significantly higher than(1.56±0.32)L and(2.41±0.43)L/s in the control group,and airway resistance(Reff value)was(0.52±0.12)kPa·L^(-1)·s^(-1),significantly lower than(0.78±0.14)kPa·L^(-1)·s^(-1) in the control group,all with statistically significant differences(P<0.05).After treatment,arterial partial pressure of oxygen(PaCO_(2))in the observation group was(42.37±4.32)mmHg,significantly lower than(49.18±4.17)mmHg of the control group,while arterial partial pressure of carbon dioxide(PaO_(2))and pH were(85.29±9.32)mmHg and 7.41±0.12,significantly higher than(73.18±8.46)mmHg and 7.32±0.10 in the control group,all with statistically sig-nificant differences(P<0.05).The incidence of adverse reactions in the observation group and the control group during treatment were 7.69%and 6.15%,with no statistically significant difference(P>0.05).Conclusion Non-invasive me-chanical ventilation combined with salbutamol aerosol inhalation can improve blood gas indexes,oxygen metabolism ability,and pulmonary function in elderly patients with COPD,with good clinical effect and high safety.