无创通气联合雾化吸入对老年慢性阻塞性肺气肿并呼吸衰竭动脉血气及肺功能的影响  

Effects of Noninvasive Ventilation Combined with Atomization Inhalation on Arterial Blood Gases and Pulmonary Function of Elderly Patients with Chronic Obstructive Pulmonary Disease Accompanied by Respiratory Failure

作　　者：任柏沉[1] 王春茂[1] 孙建[1] 张维[1] 李云辉[1] 

机构地区：[1]成都医学院第一附属医院呼吸内科,成都610500

出　　处：《临床误诊误治》2017年第6期88-92,共5页Clinical Misdiagnosis & Mistherapy

基　　金：四川省卫生厅资助项目(11ZA230)

摘　　要：目的探讨无创通气联合雾化吸入对老年慢性阻塞性肺气肿(chronic obstructive pulmonary disease,COPD)并呼吸衰竭(respiratory failure,RF)动脉血气及肺功能的影响。方法选择我院2015年7月—2016年6月收治的老年COPD并RF(COPD-RF)98例,依据随机数字表法分为联合组和无创通气组,每组各49例。两组均予常规治疗+无创正压通气治疗,联合组在此基础上予雾化吸入。观察两组治疗前后血氧分压(PaO_2)、二氧化碳分压(PaCO_2)、酸碱度(p H)等动脉血气变化,测定第一秒用力呼气容积(FEV1)、呼气高峰流量(PEFR)、用力肺活量(FVC)及呼吸频率(RR)的变化,检测基质金属蛋白酶-9(MMP-9)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)等炎性因子水平变化,记录治疗期间不良反应发生情况及临床疗效。结果与本组治疗前比较,治疗后两组PaO_2、pH、FEV1、PEFR及FVC水平均升高,PaCO_2、RR、MMP-9、hs-CRP及TNF-α水平均降低,差异有统计学意义(P<0.05);与无创正压通气组比较,联合组治疗后PaO_2、FEV1、PEFR及FVC水平升高,PaCO_2、RR、MMP-9、hs-CRP及TNF-α水平降低,差异有统计学意义(P<0.05)。联合组、无创通气组总有效率分别为93.88%、73.47%,差异有统计学意义(P<0.05)。两组治疗过程中均未出现明显不良反应。结论无创通气联合雾化吸入可显著改善老年COPD-RF动脉血气及肺功能,减轻炎性反应,且无明显不良反应。Objective To investigate effects of noninvasive ventilation combined with atomization inhalation on arteri- al blood gases and pulmonary function Df elderly patients with chronic obstructive pulmonary disease （COPD） accompanied by respiratory failure （RF）. Methods A total of 98 patients with COPD-RF admitted during July 2015 and June 2016 were di- vided into combined group （ n = 49） aad noninvasive ventilation group （ n = 49） according to random number table method. All the patients received conventional ：herapy and non-invasive positive pressure ventilation, and combined group was added with atomization inhalation. In two groups, changes of arterial blood gases indexes such as arterial oxygen tension （PaO2 ） , partial pressure of carbon dioxide （ PaCO2 ） , hydrogen ion concentration （pH） were observed; changes of forced expiratory volume in one second （FEV1 ） , peak expiratory flow rate （PEFR） , forced vital capacity （FVC） and respiratory rate （RR） were detected; level changes of inflammatory factors such as matrix metalloproteinase-9 （MMP-9） , high-sensitivity C-reactive protein （hs-CRP） and tumor necrosis factor alpha （TNF-α） were detected; incidence rate of adverse reactions during treat- ment and clinical effects were recorded. Results Compared with those before treatment in same group, levels of PaO2 , pH, FEV1 , PEFR and FVC were significar tly increased, while PaCO2, RR, MMP-9, hs-CRP and TNF-α levels were significantly decreased after treatment in two groups （P 〈 0.05 ）. After treatment, in combined group PaO2 , FEV1 , PEFR and FVC levels were significantly higher, while PaCO2, RR, MMP-9, hs-CRP and TNF-α levels were significantly lower than those in nonin- vasive ventilation group （P 〈 0.05）. The total effective rate were 93.88% in combined group and 73.47% in noninvasive ventilation group respectively, and thedifference was statistically significant （ P 〈 0. 05）. No obvious adverse reaction was found during treatment in two

关 键 词：肺疾病 慢性阻塞性 呼吸衰竭 肺功能 动脉血气 老年人 

分 类 号：R563[医药卫生—呼吸系统]