无创正压通气在支气管扩张症患者中的应用研究  

Clinical research of noninvasive positive pressure ventilation in patients with bronchiectasis

作　　者：邱志红[1] 朱明华[1] 刘华[1] 那奕文[1] 刘海涛[1] 王建新[1] 何敬堂[1] 

机构地区：[1]河北医科大学附属华北石油管理局总医院,河北任丘062552

出　　处：《现代中西医结合杂志》2017年第26期2855-2857,2860,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：中国石油华北油田科技项目(2012-HB-G08-3)

摘　　要：目的评价无创正压通气治疗支气管扩张症合并呼吸衰竭患者的临床效果。方法选择合并呼吸衰竭支气管扩张症患者114例,随机分为2组,对照组58例行常规治疗,治疗组56例在对照组治疗基础上行无创正压通气治疗,比较2组治疗前后的心率、呼吸频率(RR)、动脉血气分析、辅助呼吸肌动用评分、呼吸困难评分、肺功能、APACHEⅡ评分、6min行走距离(6MWD)、插管率、病死率及住院时间等指标的差异。结果治疗组治疗24 h后心率、RR、二氧化碳分压[p(CO_2)]、辅助呼吸肌动用评分和呼吸困难评分均明显下降,氧分压[p(O_2)]、pH值、第1秒用力呼气容积(FEV1)占预测值百分比(FEV1%)、FEV1占用力肺活量(FVC)百分比(FEV1/FVC)均明显上升(P均<0.05),而对照组直至出院前上述指标才出现显著改善(P均<0.05),出院前2组间上述指标比较差异均有统计学意义(P均<0.05);治疗组6MWD明显长于对照组(P<0.05),插管率明显低于对照组(P<0.05),住院时间明显短于对照组(P<0.05);13例插管患者APACHEⅡ评分明显高于100例未插管患者(P<0.05)。结论无创正压通气治疗支气管扩张症合并呼吸衰竭患者疗效确切,可以更快、更好地改善肺通气功能,降低插管率,缩短住院时间,但对于APACHEⅡ评分较高的危重患者选择有创机械通气治疗更为适宜。Objective It is to evaluate the effect of noninvasive positive pressure ventilation（ NPPV） in respiratory failure patients with bronchiectasis. Methods 56 bronchiectasis patients complicated with respiratory failure who had received NPPV therapy were enrolled as treatment group, another similar58 cases who had not received NPPV therapy served as control group. The heart rate , breathing rate （RR） , arterial blood gas analysis, scale for accessory muscle use, dyspnea grade, pulmonary function,APACHE II score, 6 minute walking distance （6MWD） , intubation rate and fatality rate and hospital stay were ob-served before and after treatment. Results The first day after treatment, heart rate, RR, p （ CO2 ） , scale for accessory muscle use and dyspnea grade were decreased significantly, and pH, p （ O2 ） , FEYj % , FEVj/FVC were increased obviously（P 〈 0. 05 ） compared with those before treatment in the treatment group （P 〈0. 05） , but these indexes were not improved significantly until they were leaving hospital. 6MWD, intubation rate and hospital stay were significant better in the treatment group than that in the control group （ P 〈 0. 05 ） . APACHE Ⅱ score in 13 patients with intubation were significantly higher than that of the other patients without intubation, there were also significant difference between the two groups （P 〈0.05）. Conclusion NPPV can improve pulmonary ventilation function, decrease intubation rate and reduce hospital stay in patients with respiratory failure due to bronchiectasis. The patients with high APACHE Ⅱ score are more suitable for invasive mechanical ventilation.

关 键 词：无创正压通气 支气管扩张症 呼吸衰竭 动脉血气分析 肺功能 

分 类 号：R562.22[医药卫生—呼吸系统]