早期无创机械通气治疗慢性阻塞性肺病单侧肺减容术后的疗效评价  

Evaluation of early non-invasive mechanical ventilation in treatment of chronic obstructive pulmonary disease after unilateral lung volume reduction

作　　者：吴娅秋 丛伟[3] 梁宗安[2] 曾帆 兰蕴平 

机构地区：[1]四川省医学科学院.四川省人民医院重症医学科神经外科ICU,四川成都610072 [2]四川大学华西医院呼吸与危重病科,四川成都610041 [3]四川省医学科学院.四川省人民医院胸外科,四川成都610072 [4]四川省医学科学院.四川省人民医院重症医学科外科ICU,四川成都610072

出　　处：《实用医院临床杂志》2017年第6期185-188,共4页Practical Journal of Clinical Medicine

基　　金：四川省卫生计生委科研基金资助项目(编号:川干研2015-204)

摘　　要：目的评价早期无创机械通气(noninvasive ventilation,NIV)治疗慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)单侧肺减容术(lung volumereduction surgery,LVRS)后临床疗效。方法收集125例行单侧LVRS的COPD术后患者。术前均采用CT和核素肺通气灌注扫描确定"靶区",经小切口或胸腔镜及胸腔镜辅助小切口手术。术后12小时内拔除气管插管后,其中60例早期除常规治疗外,同时给予NIV序贯治疗(B组),65例未行NIV序贯治疗组(A组)。比较两组术前、术后6个月的肺功能、血气分析及活动能力等指标的变化。结果与A组相比,B组术后6个月:一秒钟用力呼气容积高、残气量低、肺总量更高;动脉血氧分压更高、动脉血二氧化碳分压更低,六分钟步行距离更长,差异均有统计学意义(P<0.05)。28天死亡率NIV组为6%,非NIV组为3%。结论 NIV治疗COPD单侧LVRS术后患者,可能改善患者的临床症状,并有助于患者术后呼吸功能恢复,降低术后病死率。Objective To evaluate the clinical efficacy of early non-invasive ventilation （NIV） during postoperative period in the treatment of chronic obstructive pulmonary disease （COPD） after unilateral lung volume reduction surgery （LVRS）. Methods 125 COPD patients with unilateral LVRS, CT and radionuclide lung perfusion scan were performed before surgery, and the target area was determined by small incision or thoracoscopy and video-assisted thoracoscopic small incision surgery. In 12 hours after extubation, 60 cases were treated with NIV sequential therapy （group B）. Another 65 patients without NIV sequential therapy group were taken as group A. The lung function, blood gas analysis and activity index were compared before and 6 months after operation between the two groups. Results Compared with the group A,the patients in the group B showed a higher one-second-forced expiratory volume,lower residual volume, higher total lung volume,higher PaO2 and lower PaCO2,1onger six-minutes-walking distance after 6 months of the operation （P 〈0. 05）. The 28-day mortality rate was 6% in the group Aand 3% in the group B. Conclusion Early non-invasive mechanical ventilation for COPD patients with unilateral LVRS may improve the clinical symptoms, and help the recovery of postoperative respiratory function and reduce the postoperative mortality.

关 键 词：无创机械通气 肺切除术 慢性阻塞性肺疾病 呼吸锻炼 

分 类 号：R563.3[医药卫生—呼吸系统]