氧气与空气雾化对无创通气治疗慢性阻塞性肺疾病急性加重患者的效果比较

Comparison of the effects of oxygen and air nebulization on non-invasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

目的比较慢性阻塞性肺疾病急性加重患者无创机械通气同时雾化吸入时,不同雾化驱动气体对患者雾化过程中二氧化碳分压动态变化及治疗效果的影响。方法将64例慢性阻塞性肺疾病急性加重患者随机分为氧气组和空气组各32例。氧气组在无创机械通气的同时进行氧气驱动雾化吸入治疗,空气组进行空气驱动雾化吸入。记录雾化0 min、5 min、10 min、15 min,雾化结束5 min、10 min、15 min的患者经皮二氧化碳分压。记录治疗前、治疗第4天、治疗第7天动脉血气分析、CAT评分、痰液症状积分。结果两组各30例完成研究。两组雾化不同时间经皮二氧化碳分压比较,组间、时间及交互效应存在统计学差异(均P<0.05)。两组患者治疗后PaCO_(2)、pH值、CAT评分、痰液症状积分均有改善,其中PaCO_(2)在治疗第7天组间比较有统计学意义(P<0.05)。结论两种雾化驱动气体均能取得良好的治疗效果。氧气组能够使雾化过程中经皮二氧化碳分压维持相对稳定。而空气组能够降低雾化过程中经皮二氧化碳分压,适用于慢性阻塞性肺疾病急性加重伴有严重CO_(2)潴留的Ⅱ型呼吸衰竭患者。

Objective To compare the effects of different nebulization gases on the dynamic changes in partial pressure of carbon dioxide(PaCO_(2))and treatment outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)receiving non-invasive ventilation.Methods Sixty-four patients with AECOPD were randomly divided into the oxygen group and the air group,with 32 patients in each group.The oxygen group received oxygen-driven nebulization therapy during non-invasive ventilation,while the air group received air-driven nebulization therapy.The patients′transcutaneous partial pressure of carbon dioxide(PtCO_(2))was recorded at 0,5,10,15 min of nebulization,and 5,10,15 min after nebulization.Arterial blood gas analysis,COPD assessment test(CAT)score,and sputum symptom score were recorded before treatment,on the 4th day of treatment,and on the 7th day of treatment.Results Thirty cases in each group completed the study.There were statistical differences in the comparison group effect of repeated measurements of PtCO_(2)between the two groups(all P<0.05).After treatment,PaCO_(2),pH value,CAT score,and sputum symptom score improved in both groups,and the difference in PaCO_(2)between the two groups on the 7th day of treatment was statistically significant(P<0.05).Conclusion Both oxygen and air nebulization can achieve good therapeutic effects.The oxygen group can maintain a relatively stable PtCO_(2)during nebulization,while the air group can reduce PtCO_(2)during nebulization,which is suitable for type II respiratory failure patients with AECOPD.