最佳氧流量驱动布地奈德雾化吸入在慢性阻塞性肺疾病急性加重期患者中的应用

Applications of optimal flow oxygen-driven aerosol inhalation of budesonide in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期患者雾化吸入布地奈德的最佳氧流量,为提高雾化效果提供参考。方法将2019年6月至2020年12月广州市红十字会医院收治的96例慢性阻塞性肺疾病急性加重期患者按照随机数字表法分为低流量组、中流量组和高流量组,每组32例。3组患者均采用氧气雾化驱动布地奈德吸入治疗,低流量组氧流量为4 L/min,中流量组为6 L/min,高流量组为8 L/min。治疗前和治疗7 d后,比较3组呼吸动力学、肺功能以及血气分析指标的差异。结果治疗前,3组呼吸力学、肺功能以及血气分析指标比较差异无统计学意义(P>0.05)。治疗7 d后,中流量组气道峰压、气道平台压、吸气阻力分别为(22.53±3.83)cmH_(2)O(1 cmH_(2)O=0.098 kPa)、(15.97±3.01)cmH_(2)O、(23.25±2.92)cmH_(2)O·L^(-1)·s^(-1),低于低流量组和高流量组的(26.09±3.04)cmH_(2)O、(18.13±2.54)cmH_(2)O、(26.31±3.65)cmH_(2)O·L^(-1)·s^(-1)和(26.13±3.28)cmH_(2)O、(17.44±2.02)cmH_(2)O、(25.06±3.56)cmH_(2)O·L^(-1)·s^(-1),肺动态顺应性为(33.16±4.43)ml/cmH_(2)O,高于低流量组和高流量组的(29.84±3.73)、(30.47±3.53)ml/cmH_(2)O,3组比较差异有统计学意义(F值为5.96~11.82,均P<0.05)。中流量组FEV1、FEV1/FVC、FEV1占预计肺活量比值分别为(1.36±0.26)L、(49.91±5.94)%、(44.81±5.53)%,高于低流量组和高流量组的(1.23±0.19)L、(45.22±6.56)%、(40.88±5.97)%和(1.20±0.18)L、(46.41±5.30)%、(41.78±6.32)%,3组比较差异有统计学意义(F=4.91、5.36、3.84,均P<0.05)。中流量组PaO_(2)、氧合指数分别为(73.06±7.24)、(176.18±17.62)mmHg(1 mmHg=0.133 kPa),高于低流量组和高流量组的(67.16±5.10)、(164.54±12.34)mmHg和(69.44±7.10)、(167.07±16.24)mmHg;PaCO_(2)为(52.75±6.22)mmHg,低于低流量组和高流量组的(57.97±6.75)、(56.31±6.45)mmHg,3组比较差异有统计学意义(F=6.61、4.96、5.42,均P<0.05)。结论对慢性阻塞性肺疾病急性加重期患者进行布地奈德雾化吸入时,氧流量为6 L/min可有效改善患者呼吸动力学和血气分析指标,提高肺功能。

Objective To investigate of optimal flow oxygen-driven aerosol inhalation of budesonide in patients with acute exacerbation of chronic obstructive pulmonary disease,to provides a reference for improving the atomization effect.Methods Totally,ninety-six patients with acute exacerbation of chronic obstructive pulmonary disease in Guangzhou Red Cross Hospital from June 2019 to December 2020 were collected and assigned to the low flow group,middle flow group and high flow group according to the random number table method,with 32 cases in each group.All patients received oxygen-driven aerosol inhalation of budesonide therapy,the oxygen flow were 4 L/min,6 L/min and 8 L/min in the three groups,respectively.Before and after 7 days of treatment,the indices including respiratory dynamics,pulmonary function and blood gas analysis were compared among the three groups.Results There was no significant difference in the indices including respiratory dynamics,pulmonary function and blood gas analysis before treatment among the three groups(P>0.05).After 7 days of treatment,the peak airway pressure,plateau airway pressure,inspiratory resistance were(22.53±3.83)cmH_(2)O(1 cmH_(2)O=0.098 kPa),(15.97±3.01)cmH_(2)O,(23.25±2.92)cmH_(2)O·L^(-1)·s^(-1)in the middle flow group,lower than those in the low flow group(26.09±3.04)cmH_(2)O,(18.13±2.54)cmH_(2)O,(26.31±3.65)cmH_(2)O·L^(-1)·s^(-1)and high flow group(26.13±3.28)cmH_(2)O,(17.44±2.02)cmH_(2)O,(25.06±3.56)cmH_(2)O·L^(-1)·s^(-1),the pulmonary dynamic compliance was(33.16±4.43)ml/cmH_(2)O in the middle flow group,higher than that in the low flow group and high flow group(29.84±3.73),(30.47±3.53)ml/cmH_(2)O,the differences were statistically significant(F values were 5.96-11.82,all P<0.05).The FEV1,FEV1/FVC,ratio of FEV1 to estimated vital capacity were(1.36±0.26)L,(49.91±5.94)%,(44.81±5.53)%in the middle flow group,higher than those in the low flow group and high flow group(1.23±0.19)L,(45.22±6.56)%,(40.88±5.97)%and(1.20±0.18)L,(46.41±5.30)%,(41.78±6.32)%,the differences were statistically significant(F=4.91,5.36,3.84,all P<0.05).The PaO_(2),oxygenation index were(73.06±7.24),(176.18±17.62)mmHg(1 mmHg=0.133 kPa)in the middle flow group,higher than those in the low flow group and high flow group(67.16±5.10),(164.54±12.34)mmHg and(69.44±7.10),(167.07±16.24)mmHg,PaCO_(2)was(52.75±6.22)mmHg in the middle flow group,lower than that in the low flow group and high flow group(57.97±6.75),(56.31±6.45)mmHg,the differences were statistically significant(F=6.61,4.96,5.42,all P<0.05).Conclusions Oxygen-driven aerosol inhalation of budesonide for acute exacerbation of chronic obstructive pulmonary disease patients,oxygen flow are 6 L/min can effectively improve the indices of respiratory dynamics and blood gas analysis as well as improve pulmonary function.