无创正压通气对AECOPD患者呼吸肌疲劳的治疗作用  

Treatment of respiratory muscle fatigue in patients with AECOPD by non-invasive positive pressure ventilation

作　　者：尚东[1] 党晓敏[1] 杨岚[1] 韩建峰[2] 孙忠民[1] 冯思芳[1] 阳甜[1] 马爱群[3] 

机构地区：[1]西安交通大学医学院第一附属医院呼吸与危重症医学科,陕西西安710061 [2]西安交通大学医学院第一附属医院神经内科,陕西西安710061 [3]西安交通大学医学院第一附属医院心内科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2014年第6期824-827,847,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省科技发展计划项目(No.2008K14-08)~~

摘　　要：目的采用随机平行对照研究,评价无创正压通气(NPPV)对于轻度慢性阻塞性肺疾病急性加重期(AECOPD)患者早期治疗的效果。方法符合入选标准和排除标准的轻度AECOPD的40例患者,随机分为NPPV组和对照组进行治疗并观察治疗前后血气指标、呼吸肌疲劳指标的改变以及医疗花费情况。结果 NPPV组和对照组的PaCO2和pH值差异无统计学意义。NPPV组在治疗2h时PaO2[(79.81±50.3)mmHg]明显升高,和对照组[(64.29±33.2)mmHg]比较差异有统计学意义。NPPV组膈神经动作电位[(200.67±54.0)μV]较治疗前[(127.03±36.0)μV]以及对照组[(150.53±52.0)μV]显著提高,均有统计学意义。NPPV组6min步行距离[(400.25±70.5)m]较治疗前增加,和对照组[(338.41±70.9)m]比较差异有统计学意义。NPPV组的住院天数缩短,但同时治疗花费也增多,和对照组比较差异均有统计学意义。结论 NPPV对轻度AECOPD患者早期干预治疗后可以改善PaO2,缓解呼吸肌疲劳,提高活动耐力,但对PaCO2和pH值无改善。Objective A randomized parallel control study was conducted to evaluate the effect of non- invasive positive pressure ventilation （NPPV） on early treatment of patients with mild acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods We selected 40 patients with mild AECOPD according to the inclusion and exclusion criteria and randomly divided them into NPPV group and control group. The changes of blood gas index and respiratory muscle fatigue index as well as hospitalization cost were observed before and after treatment. Results There was no significant difference in PaCO2 or pH value between NPPV group and control group. PaO2 [（79.81±50.3）mmHg] significantly increased at 2 h after treatment in NPPV group compared with that in control group [（64.29±33.2）mmHg] （P〈0.05）. The phrenic nerve action potential significantly increased in NPPV group [（200.0±54.0）μV] compared with that before treatment （127.0±36.0）μV and that in control group [ （150.0± 52.0）/μV] （ P 〈 0.05）. In NPPV group, six-minute walk distance [（400.2±70.5） m] increased compared with that before treatment [（340. 19± 60.8）m] and it was significantly different from that in control group [（338.4±70.9）m] （P〈0.05）. The length of hospital stay shortened but hospitalization cost increased in NPPV group compared with those in control group. Conclusion NPPV can improve PaO2, relieve respiratory muscle fatigue, and improve activity tolerance in patients with mild AECOPD after early intervention treatment, but does not improve PaCO2 or pH.

关 键 词：慢性阻塞性肺疾病 无创正压通气 呼吸肌疲劳 膈肌肌电图 

分 类 号：R563[医药卫生—呼吸系统]