Clinical Analysis of Early Application of Bi-level Positive Airway Pressure ventilation in the Treatment of COPD with Type II Respiratory Failure

Objective:To analyze the clinical efficacy of early application of bi-level positive airway pressure ventilation in the treatment of COPD with type II respiratory failure.Method:A total of 58 patients with COPD and type II respiratory failure admitted to our hospital from January 2017 to January 2019 were randomly divided into observation group and control group,with 29 cases in each group.Among them,the control group was received routine treatment while the observation group was treated with bi-level positive pressure airway ventilation in addition of conventional treatment.The arterial blood gas analysis,mortality rate and hospitalization time of these two groups before and after treatment were compared.Result:The blood pH,partial pressure of oxygen(PaO2)and arterial oxygen saturation(SaO2)of these two groups were significantly higher after the treatment while PaO2 alone was decreased.The difference was statistically significant(P<0.05).The results of arterial blood gas analysis in the observation group were significantly improved compared with those before treatment.The mortality rate and hospitalization time were significantly less than the control group,and the difference was statistically significant(P<0.05).Conclusion:Early clinical application of bi-level positive airway pressure ventilation in the treatment of COPD with type II respiratory failure has a significant clinical effect in reducing the mortality rate and hospitalization time of patients,and thus it is worthy of clinical application.

Clinical efficacy of mask continuous positive airway pressure mechanical ventilation in children with severe pneumonia

Objective: To investigate the clinical effects of the mask continuous positive airway pressure (CPAP) mechanical ventilation in children with severe pneumonia. Methods: A total of 100 cases of children with severe pneumonia were randomly divided into two groups, study group with 50 children and control group with 50 children. These 100 children were given comprehensive treatment measures: treatment of anti-infection, anti-respiratory failure, anti-heart failure (if necessary), relieving cough and reducing sputum, aerosol inhalation, limited fluid volume, nutrition support etc. Children in the study group were added mask continuous positive airway pressure mechanical ventilation (CPAP). Children in the control group were added ordinary mask oxygen inhalation. Investigated and checked the treatment effect in these two groups. Results: After treatment, SaO2, PaO2 in both two groups were showed significantly higher than before the treatment. PaO2 of the study group is obviously higher than the control group. The oxygen inhalation time of the study group was obviously lesser than the control group. The total effective rate of the study group was significantly higher than the control group which was 96.0% vs 66.0%. Conclusion: The mask continuous positive airway pressure (CPAP) mechanical ventilation can significantly improve the related symptoms and blood gas status of the children with severe pneumonia, shorten the oxygen inhalation time and had remarkable effect.

Bi-level Nasal Positive Airway Pressure(BiPAP)versus Nasal Continuous Positive Airway Pressure(CPAP)for Preterm Infants with Birth Weight Less Than 1500g and Respiratory Distress Syndrome Following INSURE Treatment:A Two-center Randomized Controlled Trial

The present study aimed to examine the effectiveness of bi-level positive airway pressure(BiPAP)versus continuous positive airway pressure(CPAP)in preterm infants with birth weight less than 1500 g and respiratory distress syndrome(RDS)following intubation-surfactant-extubation(INSURE)treatment.A two-center randomized control trial was performed.The primary outcome was the reintubation rate of infants within 72 h of age after INSURE.Secondary outcomes included bronchopulmonary dysplasia(BPD),necrotizing enterocolitis(NEC),retinopathy of prematurity(ROP)and incidences of adverse events.Lung function at one year of corrected age was also compared between the two groups.There were 140 cases in the CPAP group and 144 in the BiPAP group.After INSURE,the reintubation rates of infants within 72 h of age were 15%and 11.1%in the CPAP group and the BiPAP group,respectively(P>0.05).Neonates in the BiPAP group was on positive airway pressure(PAP)therapy three days less than in the CPAP group(12.6 d and 15.3 d,respectively,P<0.05),and on oxygen six days less than in the CPAP group(20.6 d and 26.9 d,respectively,P<0.05).Other outcomes such as BPD,NEC,ROP and feeding intolerance were not significantly different between the two groups(P>0.05).There was no difference in lung function at one year of age between the two groups(P>0.05).In conclusion,after INSURE,the reintubation rate of infants within 72 h of age was comparable between the BiPAP group and the CPAP group.BiPAP was superior to CPAP in terms of shorter durations(days)on PAP support and oxygen supplementation.There were no differences in the incidences of BPD and ROP,and lung function at one year of age between the two ventilation methods.

The Value of Positive Pressure Ventilations for Clients in Acute Respiratory Distress as a Result of Cardiac and Pulmonary Issues

Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chronic obstructive pulmonary disease (COPD) and asthma. Limitations to successful NIV and CPAP therapy were evaluated to determine how prolonged initiation of treatment may lead to hypoxemia (decreased oxygen in the blood) and hypercapnia (increased carbon dioxide in the blood) resulting in poor outcomes. Method: Reviews of literature from nursing and allied health data bases (CINAHL and ProQuest) with terms pulmonary edema, positive pressure device and non-invasive ventilation from 2010 to 2014 were used. Studies were conducted in the hospital and prehospital settings. Results: The literature search located 7 articles from CINAHL and 25 articles from ProQuest. A total of 6 of these articles were analyzed. Additional sources of data were obtained from Ignatavicius and Workman (2013) Medical-Surgical Nursing Patient-Centered Collaborative Care 7th edition and American Journal of Nursing (02/2013) Volume 113: 2. Conclusion: All of the articles concluded that early initiation of continuous positive airway pressure ventilations in the short-term was beneficial;however, late initiation of therapy required additional interventions. The studies indicated that early use of positive airway pressure in acute respiratory distress improved breath rate, heart rate and blood pressure. The use of positive airway pressure for respiratory distress may decrease the need for endotracheal intubation.

Creation method for bi-level positive airway pressure based on pressure and flow feedback

An airway pressure and flow data acquisition system is developed to investigate the approach to building the bi-level positive airway pressure BiPAP in a ventilator.A number of experiments under different breathing situations and states are conducted and the experimental data are recorded.According to the data from these experiments the variation characteristics of the pressure and flow are analyzed using Matlab. The data analysis results show that the pressure increases while the flow decreases in the expiratory phase contrarily the pressure decreases while the flow increases in the inspiratory phase during the apnea state both the pressure and the flow remain unchanged. According to the above variation characteristics of breath a feedback-based method for creating bi-level positive airway pressure is proposed. Experiments are implemented to verify the BiPAP model. Results demonstrate that the proposed method works effectively in following respiration and caters well to most polypnea and apnea events.

Airway Pressure Release Ventilation Improves Oxygenation in a Patient with Pulmonary Hypertension and Abdominal Compartment Syndrome

The following case describes the favorable application of airway pressure release ventilation (APRV) in a patient with pulmonary hypertension who developed respiratory failure and abdominal compartment syndrome after abdominal closure from an incarcerated umbilical hernia. A 66-year-old male with past medical history of restrictive lung disease, obstructive sleep apnea and pulmonary hypertension, presented to the operating room for an incarcerated inguinal hernia. After abdominal closure, he gradually developed decreased oxygen saturation and hypotension. APRV was initiated during post operative day 2 after inability to maintain adequate oxygen saturation with resultant hypotension on pressure control ventilation with varying degrees of positive end expiratory pressure and 100% inspired oxygen concentration. The initial set high pressure on APRV was 35 mm Hg. Yet, in lieu of decreasing lung compliance, it peaked at 50 mm Hg. Eventually, inhaled Nitric Oxide was initiated post operative day 3 due to increasing pulmonary arterial pressures. A bedside laparotomy was eventually performed when bladder pressures peaked to 25 mm Hg. APRV gradually and temporally improved the oxygen saturation and decreased the pulmonary arterial pressures with subsequent increase in systemic blood pressures. APRV promoted alveolar recruitment and decreased the shunting associated with abdominal compartment syndrome. Better oxygen saturations lead to increases in blood pressure by decreasing the effects of hypoxic pulmonary vasoconstriction on the right ventricle (RV). In patients with decreasing lung compliance and pulmonary comorbidities, APRV appears safe and allows for improve oxygenation, after failure with conventional modes of ventilation.

Noninvasive Ventilation Interfaces in the Treatment of Acute Respiratory Insufficiency: A Critical Review

Background: Noninvasive ventilation (NIV) is an important therapeutic modality for the treatment of acute respiratory failure (ARF). In this review, we critically analyze randomized controlled trials on the most used NIV interfaces in the treatments of ARF. Methods: The searches were conducted in the Medline, Lilacs, PubMed, Cochrane, and Pedro databases from June to November 2021. The inclusion criteria were Randomized clinical trials (RCTs) published from 2016 to 2021 in Portuguese, Spanish, or English and involving adults (aged ≥ 18 years). The eligibility criteria for article selection were based on the PICO strategy: Population—Adults with ARF;Intervention—NIV Therapy;Comparison—Conventional oxygen therapy, high-flow nasal cannula (HFNC) oxygen therapy, or NIV;Outcome—improvement in ARF. The search for articles and the implementation of the inclusion criteria were independently conducted by two researchers. Results: Seven scientific articles involving 574 adults with ARF due to various causes, such as chest trauma, decompensated heart failure, coronavirus disease 2019 (COVID-19), and postoperative period, among others, were included. The interfaces cited in the studies included an oronasal mask, nasal mask, full-face mask, and helmet. In addition, some favorable outcomes related to NIV were reported in the studies, such as a reduction in the rate of orotracheal intubation and shorter length of stay in the ICU. Conclusions: The most cited interfaces in the treatment of ARF were the oronasal mask and the helmet.

BiPAP无创呼吸机联合噻托溴铵对AECOPD伴呼吸衰竭患者呼吸强度及肺功能的影响

目的:探究双水平气道正压通气(BiPAP)无创呼吸机联合噻托溴铵对急性加重期慢性阻塞性肺疾病(AECOPD)伴呼吸衰竭(呼衰)患者呼吸强度及肺功能的影响。方法:选取2020年10月—2022年9月瑞金市人民医院急诊科收治的AECOPD伴呼衰患者68例,随机分为对照组和观察组,各34例。对照组予以单独Bi PAP无创呼吸机治疗,观察组在对照组的基础上加用噻托溴铵,均治疗10 d。评价两组的治疗效果及不良反应发生情况,比较两组治疗前、治疗10 d后血气、呼吸动力学及肺功能指标。结果:观察组治疗总有效率高于对照组,差异有统计学意义(88.24%vs 67.65%)(P<0.05)。治疗10 d后,观察组动脉血氧分压(PaO_(2))、氧合指标(PaO_(2)/FiO_(2))、动脉血氧饱和度(SaO_(2))、吸气峰值压(PIP)、第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、最高呼气流速(PEF)及最大呼气中段流量(MMEF)均高于对照组,其动脉血二氧化碳分压(PaCO_(2))、平台压(Pplat)、平均气道压(MPaw)及气道阻力(Raw)均低于对照组,差异均有统计学意义(P<0.05)。对照组和观察组不良反应发生率分别为5.88%和11.76%,差异无统计学意义(P>0.05)。结论:BiPAP无创呼吸机联合噻托溴铵治疗可有效改善AECOPD伴呼衰患者呼吸强度,且能够改善患者肺功能,调节血氧水平,有效且安全。

BiPAP联合经管道雾化吸入糖皮质激素治疗AECOPD合并Ⅱ型呼吸衰竭的疗效及对肺动脉压力和外周血EOS水平的影响

目的 探究双水平正压通气(BiPAP)联合经管道雾化吸入糖皮质激素(GC)治疗慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭(T2RF)的疗效及对患者肺动脉压力(PAP)和外周血嗜酸性粒细胞(EOS)水平的影响。方法 选取2022年4月至2023年4月陕西省康复医院收治的80例AECOPD合并T2RF患者为研究对象,依据随机数表法分为接受BiPAP治疗的对照组(40例)和接受BiPAP联合经管道雾化吸入GC治疗的观察组(40例),两组均治疗2周。比较两组患者的临床疗效以及治疗前后的肺功能、血气指标和炎症指标,并评估治疗期间两组患者的不良反应发生情况。结果 观察组患者的治疗总有效率为97.50%,明显高于对照组的80.00%,差异具有统计学意义(P<0.05);治疗后,观察组患者的用力肺活量(FVC)、第一秒用力呼吸气容积(FEV_(1))分别为(1.99±0.53) L、(2.55±0.45) L,明显高于对照组的(1.72±0.46) L、(2.11±0.52) L,差异均有统计学意义(P<0.05);治疗后,观察组患者的氧分压(PaO_(2))为(85.34±12.39) mmHg,明显高于对照组的(71.43±11.87) mmHg,二氧化碳分压(PaCO_(2))为(60.11±8.35) mmHg,明显低于对照组的(69.06±9.84) mmHg,差异均有统计学意义(P<0.05);治疗后,观察组患者的白细胞介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)和EOS水平分别为(42.37±5.72) ng/L、(23.71±5.21) ng/L、(4.53±1.13)%,明显低于对照组的(51.19±6.37) ng/L、(32.63±6.01) ng/L、(8.46±2.14)%,差异均有统计学意义(P<0.05);治疗期间,观察组患者的不良反应总发生率为10.00%,略高于对照组的5.00%,但差异无统计意义(P>0.05)。结论 BiPAP联合经管道雾化吸入GC治疗AECOPD合并T2RF可明显改善患者的肺功能指标、血气和炎症状态,临床应用效果显著且安全性较高,具有临床应用价值。

抗感染药物联合BiPAP无创通气治疗老年呼吸衰竭的疗效观察

目的浅析老年呼吸衰竭采取抗感染药物联合双水平气道正压通气呼吸机(BiPAP)无创通气治疗的临床价值。方法68例老年呼吸衰竭患者,依据随机数字表法分为对照组与研究组,各34例,对照组接受常规抗感染药物,研究组接受抗感染药物联合BiPAP无创通气治疗。比较两组患者治疗前后的心率、呼吸频率、动脉血气指标[动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))]、肺功能指标[第1秒钟用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC]、不良反应发生情况。结果治疗1、2 d后,研究组患者心率分别为(97.42±7.62)、(85.13±4.91)次/min,呼吸频率分别为(21.72±6.50)、(20.05±4.13)次/min,均低于对照组的(101.58±9.34)、(99.72±7.68)、(26.97±5.87)、(24.97±4.25)次/min,差异有统计学意义(P<0.05)。治疗7 d后,研究组患者PaCO_(2)(44.08±2.67)mm Hg(1 mm Hg=0.133 kPa)低于对照组的(50.27±3.16)mm Hg,PaO_(2)(79.14±5.91)mm Hg、SaO_(2)(91.98±8.67)%均高于对照组的(67.15±5.12)mm Hg、(83.41±8.52)%,差异有统计学意义(P<0.05)。治疗7 d,研究组患者FEV1(2.04±0.72)L、FVC(3.11±0.41)L、FEV1/FVC(72.47±9.27)%均高于对照组的(1.68±0.61)L、(2.67±0.48)L、(64.18±8.26)%,差异有统计学意义(P<0.05)。研究组不良反应发生率8.82%低于对照组的29.41%,差异有统计学意义(P<0.05)。结论老年呼吸衰竭患者给予抗感染药物联合BiPAP无创通气治疗具有积极意义,可有效改善患者的临床症状,提高氧合及肺功能,具有推广价值。

慢阻肺急性加重期伴呼吸衰竭的BIPAP结合硫酸特布他林雾化溶液吸入治疗效果及对免疫功能影响

目的探究慢性阻塞性肺疾病(简称慢阻肺)急性加重期伴呼吸衰竭患者采用双水平气道正压通气(Bi-level Positive Airway Pressure,BIPAP)结合硫酸特布他林雾化溶液吸入的临床疗效。方法选取2022年1—12月江苏省沭阳仁慈医院收治的60例慢阻肺急性加重期伴呼吸衰竭患者为研究对象,依据随机数字表法分为对照组和观察组,各30例。对照组采用BIPAP治疗,观察组采用硫酸特布他林+BIPAP治疗,比较两组患者的免疫功能水平、血气指标、肺功能指标。结果观察组患者的各项免疫功能水平和血气指标水平优于对照组,差异有统计学意义(P均<0.05)。观察组患者的肺功能指标高于对照组,差异有统计学意义(P<0.05)。结论慢阻肺急性加重期伴呼吸衰竭疾病病情重,危及患者机体健康,采用BIPAP与硫酸特布他林联用,可快速恢复免疫功能,改善血气,并提高肺功能。

Clinical characteristics and outcomes associated with nasal intermittent mandatory ventilation in acute pediatric respiratory failure

AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU) or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortality Ⅲ(PRIsM-Ⅲ) scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV) were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%) failed treatment and required MV.The majority of the patients(74%) had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P = 0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲ scores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P < 0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support.

BiPAP无创正压通气对急性心力衰竭伴呼吸衰竭患者HRV、心肺功能的影响

目的探究双水平气道正压通气(BiPAP)对急性心力衰竭(AHF)伴呼吸衰竭(RF)患者心率变异性(HRV)、心肺功能的影响。方法选择西部战区总医院急诊学科抢救室2020年10月—2021年10月期间收治入院的155例AHF伴RF患者,按照随机数字表法分为BiPAP组(n=77)和CPAP组(n=78),比较两组患者症状改善情况、HRV及心肺功能。结果两组AHF伴RF患者均无死亡,ICU住院时间、无创通气时间、症状缓解时间、插管率差异均无统计学意义(P>0.05)。治疗前,两组AHF伴RF患者正常心脏搏动周期(RR)间期标准差(SDNN)、RR间期平均值标准差(SDANN)、相邻心跳连续差均方根(RMSSD)、低频功率(LF)、高频功率(HF)、左心室射血分数(LVEF)、心输排血(CO)、心脏指数(CI)、每搏输出量(SV)、动脉血氧分压(PaO_(2))、血氧饱和度(SaO_(2))、动脉血二氧化碳分压(PaCO_(2))差异均无统计学意义(P>0.05);治疗后,BiPAP组SDNN、SDANN、RMSSD、LF、HF、LVEF、CO、CI、SV、PaO_(2)、SaO_(2)均上升,CPAP组RMSSD较治疗前无变化,其余均上升,两组PaCO_(2)均下降,BiPAP组SDNN、SDANN、RMSSD、LF、HF、PaO_(2)、SaO_(2)高于CPAP组(P<0.05),PaCO_(2)低于CPAP组(P<0.05),两组间LVEF、CO、CI、SV差异无统计学意义(P>0.05)。结论BiPAP、CPAP均能显著改善AHF伴RF患者的临床症状、HRV和心肺功能,但BiPAP对HRV和肺功能的改善效果更显著。

Effectiveness of adaptive servo-ventilation

Adaptive servo-ventilation(ASV) has been developed as a specific treatment for sleep-disordered breathing, in particular Cheyne-Stokes respiration with central sleep apnea(CSA). Heart failure patients often have sleep-disordered breathing, which consists of either obstructive sleep apnea(OSA) or CSA. Other medical conditions, such as stroke, acromegaly, renal failure, and opioid use may be associated with CSA. Continuous positive airway pressure(CPAP) therapy is widely used for patients with OSA, but some of these patients develop CSA on CPAP, which is called treatmentemergent CSA. CPAP can be useful as a treatment for these various forms of CSA, but it is insufficient to eliminate respiratory events in approximately half of patients with CSA. As compared to CPAP, ASV may be a better option to treat CSA, with sufficient alleviation of respiratory events as well as improvement of cardiac function in heart failure patients. In patients without heart failure, ASV can also alleviate CSA and relieve their symptom. Recently, ASV has been widely used for patients with various forms of CSA. ASV may be also used in the setting without CSA, but it should be assessed more carefully. Clinicians should have a better understanding of the indications for ASV in each setting.

BIPAP辅助纤维支气管镜肺泡灌洗对ICU重症肺炎合并呼吸衰竭患者的疗效

目的:分析双水平气道正压通气(BIPAP)辅助纤维支气管镜肺泡灌洗对重症监护室(ICU)重症肺炎合并呼吸衰竭患者的疗效。方法:回顾性分析2021年4月至2023年4月莆田学院附属医院收治的98例ICU重症肺炎合并呼吸衰竭患者的临床资料,按治疗措施的不同分为对照组和观察组。其中单纯行BIPAP的47例患者纳入对照组,行BIPAP辅助纤维支气管镜肺泡灌洗治疗的51例患者纳入观察组,均持续治疗1周。比较两组患者临床疗效、呼吸功能指标、血气分析指标、炎症因子水平。结果:观察组患者临床疗效率高于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组患者呼吸频率、氧合指数、动态顺应性均优于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组患者动脉血氧分压(PaO_(2))高于对照组,动脉血二氧化碳分压(PaCO_(2))低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组患者血清C反应蛋白(CRP)、降钙素原(PCT)水平、白细胞(WBC)计数均低于对照组,差异具有统计学意义(P<0.05)。结论:BIPAP辅助纤维支气管镜肺泡灌洗对ICU重症肺炎合并呼吸衰竭患者的疗效显著,能够减轻患者机体炎症反应,改善呼吸功能与血气分析指标,促进临床症状消退。

气道正压通气对阻塞性睡眠呼吸暂停低通气综合征合并高血压患者的影响

目的探究气道正压通气对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者睡眠呼吸暂停低通气指数(AHI)、血压及认知功能的影响。方法选取2022年3月至2023年1月上海市第八人民医院收治的88例OSAHS合并高血压患者,按照随机数字表法分为干预组(44例)与对照组(44例)。对照组采用常规治疗,干预组在对照组的基础上加用气道正压通气治疗。比较2组患者的睡眠监测结果、血压水平、认知和嗜睡评定及生活质量。结果治疗后干预组患者的AHI和最长呼吸暂停时间数值均比治疗前降低(P<0.05),且干预组的数值均较对照组更低(P<0.05);治疗后2组24 h平均收缩压、舒张压和夜间收缩压、舒张压均降低,且干预组的血压水平降低幅度较对照组更明显(P<0.05);治疗后2组患者的蒙特利尔认知评估量表(MoCA)评分均有提升,Epworth嗜睡量表(ESS)评分均有下降,且干预组患者的MoCA和ESS量表评分升高、下降幅度均超过对照组(P<0.05);治疗后2组患者的社会生活、物质生活、生理功能和躯体功能指标均有提升,且干预组各项指标较对照组更高(P<0.05)。结论气道正压通气能有效降低OSAHS合并高血压患者的AHI指数,降低患者的血压水平,改善患者的认知功能。

肠内-肠外联合营养联合双水平气道正压通气对COPD急性加重期合并Ⅱ型呼吸衰竭患者的应用效果探讨

目的探讨分析肠内-肠外联合营养联合双水平气道正压通气对COPD急性加重期合并Ⅱ型呼吸衰竭患者的应用效果。方法选择2022年3月-2023年2月本院呼吸内科收治的118例COPD急性加重期合并Ⅱ型呼吸衰竭患者作为研究对象,按照随机数表法分成实验组和对照组两组,每组各59例。对照组患者给予常规治疗、肠道内营养支持以及经鼻持续低流量吸氧,实验组患者给予肠内-肠外联合营养支持联合双水平气道正压通气。对比治疗前与治疗1周后的肺功能指标、血气分析指标、营养指标以及住院基本情况。结果实验组ICU住院时间、总住院时间均短于对照组,住院期间气管切开率和28 d病死率明显低于对照组(P<0.05)。经不同方法治疗后,两组患者用力肺活量(FVC)、第1秒用力呼气容积占预计值的百分比(FEV1%)和最大的呼气流量(PEF)均高于治疗前,且实验组高于对照组;两组患者氧气分压(PaO_(2))、血酸碱度(pH)、血氧饱和度(SaO_(2))均高于治疗前,且实验组高于对照组,两组患者二氧化碳分压(PaCO_(2))低于治疗前,且实验组低于对照组;两组患者前白蛋白(PA)、白蛋白(ALB)、总蛋白(TP)均高于治疗前,且实验组高于对照组(P<0.05)。结论对COPD急性加重期合并Ⅱ型呼吸衰竭患者采取肠内-肠外联合营养联合双水平气道正压通气方式辅助的治疗方法,可以明显提高患者康复速度、缩短住院时间,在改善患者营养状况、血气功能与肺功能方面作用明显。

中医培土化浊方、针刺结合持续气道正压通气在阻塞性睡眠呼吸暂停低通气综合征患者中疗效分析

目的观察中医培土化浊方、针刺结合持续气道正压通气(CPAP)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)中的临床疗效。方法选取2020年5月—2022年5月收治的120例OSAHS患者作为研究对象,随机分为对照组(n=30)、药物+CPAP组(A组,n=29)、针刺+CPAP组(B组,n=27)以及联合组(n=34)共4组。对照组采用单独CPAP治疗,联合组采用培土化浊方内服+针刺+CPAP治疗,治疗周期为1个月。观察4组患者临床疗效,评估治疗前后4组患者中医证候积分、嗜睡程度、通气功能[呼吸暂停通气指数(AHI)、最低血氧饱和度(LSaO_(2))、最长呼吸暂停时间(LAT)]以及生活质量变化。结果治疗1个月后联合组临床疗效为94.12%,较对照组、A组以及B组临床疗效(72.41%、74.07%、56.67%)均明显更高(均P<0.05)。与治疗前比较,4组患者中医证候积分、嗜睡程度、通气功能以及生活质量均明显改善(均P<0.05),联合组中医证候积分、嗜睡程度评分、AHI以及LAT均低于对照组、A组与B组(均P<0.05),联合组LSaO_(2)以及生活质量评分均高于对照组、A组与B组(均P<0.05),对照组、A组与B组3组间中医证候积分、嗜睡程度评分、AHI、LSaO_(2)、LAT以及生活质量评分比较差异无统计学意义(均P>0.05)。结论中医培土化浊方、针刺结合CPAP联合治疗可有效提高OSAHS患者临床疗效,缓解其临床症状,提高通气功能,改善患者生活质量。

综合护理干预对阻塞性睡眠呼吸暂停低通气综合征患者生命质量的作用

目的:探讨综合护理干预对青海地区阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者生命质量的改善效果。方法:选取2019年1月至2021年12月在青海红十字医院睡眠医学科行多导睡眠监测(PSG)和无创呼吸机治疗的中重度OSAHS住院患者392例作为研究对象,根据收治的时间登记表单双号顺序将患者分为对照组(单号)和观察组(双号),每组196例。对照组给予普通护理,观察组给予综合护理。比较2组干预前后Epworth嗜睡量表(ESS)、焦虑自评量表(SAS)、睡眠呼吸暂停生命质量指数(SAQLl)评分及干预后持续气道正压通气(CPAP)治疗依从性。结果:干预后,2组患者ESS、SAS评分均低于本组干预前(均P<0.05),且观察组干预后ESS、SAS评分均低于对照组(均P<0.05)。干预后,2组患者SAQLI日常活动、社会影响、情感活动、症状评分均高于本组干预前(均P<0.05),且观察组干预后SAQLI日常活动、社会影响、情感活动、症状评分均高于对照组(均P<0.05)。观察组干预后完成CPAP治疗患者例数明显多于对照组(P<0.05)。结论:综合护理干预后可显著提高患者CPAP治疗的依从性,提高疗效,提高患者的生命质量。