无创机械通气联合呼吸训练在AECOPD合并呼吸衰竭患者中的应用评价

Application Evaluation of Non-invasive Ventilation Combined with Respiration Training in Patients with AECOPD Complicated with Respiratory Failure

目的:探讨无创机械通气联合呼吸训练对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者的效果。方法:前瞻性纳入2019年2月—2022年2月桂林医学院附属医院急诊科收治的AECOPD合并呼吸衰竭患者共67例,采用随机数字表法将患者分为两组。对照组(n=33)接受间断无创机械通气治疗,观察组(n=34)在对照组基础上增加主动呼吸训练(包括上肢弹力带阻抗训练、缩唇腹式呼吸、呼吸训练器使用)。记录两组2 d内撤机成功率、不良反应发生率,比较两组氧合指数(OI)、动脉血二氧化碳分压(PaCO_(2))、改良版英国医学研究委员会(mMRC)呼吸困难问卷分级、呼吸频率(RR)、自主呼吸潮气量。结果:对照组2 d内撤机成功率为60.6%,观察组为82.4%,观察组的撤机成功率高于对照组(P<0.05);观察组咳痰乏力、呼吸疲劳发生率均低于对照组(P<0.05);与治疗前相比,两组患者治疗2 d后的OI和PaCO_(2)均有显著改善,差异均有统计学意义(P<0.05);治疗2 d后,观察组PaCO_(2)低于对照组(P<0.05),但两组OI比较,差异无统计学意义(P>0.05);与治疗前相比,两组患者治疗2 d后的mMRC呼吸困难问卷分级和RR均有明显下降,自主呼吸潮气量均有明显提升,差异均有统计学意义(P<0.05);治疗2 d后,两组mMRC呼吸困难问卷分级和RR比较,差异均无统计学意义(P>0.05),但观察组患者自主呼吸潮气量明显高于对照组(P<0.05)。结论:AECOPD合并呼吸衰竭患者进行无创机械通气联合呼吸训练,能有效改善呼吸肌疲劳,增加肺通气,提高撤机成功率。

Objective:To explore the effect of non-invasive ventilation combined with respiration training on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure.Method:A total of 67 patients with AECOPD complicated with respiratory failure admitted to Department of Emergency,Affiliated Hospital of Guilin Medical University from February 2019 to February 2022 were prospectively included,and the patients were divided into two groups according to random number table method.The control group(n=33)received intermittent non-invasive ventilation treatment,and the observation group(n=34)was supplemented with active respiration training(including upper limb elastic band impedance training,pursedlip abdominal breathing,and the use of respiratory trainer)on the basis of the control group.The weaning success rate within 2 days and the incidence of adverse reactions were recorded between the two groups,and the oxygenation index(OI),arterial partial pressure of carbon dioxide(PaCO_(2)),modified medical research council(mMRC)dyspnoea questionnaire grade,respiratory rate(RR)and spontaneous breathing tidal volume were compared between the two groups.Result:The weaning success rate within 2 days was 60.6%in control group and 82.4%in observation group,and the weaning success rate in observation group was higher than that in control group(P<0.05).The incidences of expectoration inertia and respiratory fatigue in observation group were lower than those in control group(P<0.05).Compared with those before treatment,the OI and PaCO_(2)of the two groups were significantly improved after 2 days of treatment,the differences were statistically significant(P<0.05).After 2 days of treatment,PaCO_(2)in the observation group was lower than that in the control group(P<0.05),but there was no significant difference in OI between the two groups(P>0.05).Compared with those before treatment,after 2 days of treatment,mMRC dyspnoea questionnaire grade and RR of the two groups were significantly decreased,and the spontaneous breathing tidal volume were significantly increased,the differences were statistically significant(P<0.05).After 2 days of treatment,there were no significant differences in mMRC dyspnoea questionnaire grade and RR between the two groups(P>0.05),but the spontaneous breathing tidal volume in the observation group was significantly higher than that in the control group(P<0.05).Conclusion:Non-invasive ventilation combined with respiration training for patients with AECOPD complicated with respiratory failure can effectively improve respiratory muscle fatigue,increase lung ventilation,and improve weaning success rate.