无创通气序贯治疗慢性阻塞性肺疾病急性加重合并呼吸衰竭的效果  

Effect of sequential non-invasive ventilation for acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure

作　　者：钟春苗[1] 嵇朝晖[1] 周萍萍[1] 胡先全[1] 傅恺 ZHONG Chunmiao;JI Zhaohui;ZHOU Pingping;HU Xianquan;FU Kai(Emergency Department, the First People＇s Hospital of Huzhou City, Zhejiang Province, Huzhou 313000, China)

机构地区：[1]浙江省湖州市第一人民医院急诊科,浙江湖州313000

出　　处：《中国医药导报》2018年第14期89-92,106,共5页China Medical Herald

基　　金：浙江省医药卫生科技计划项目(2018KY773)

摘　　要：目的探讨慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭应用无创通气序贯(NIPPV)治疗的临床价值。方法选择2015年7月~2017年7月浙江省湖州市第一人民医院收治的120例AECOPD合并呼吸衰竭患者,采用随机数字表法分为两组,每组各60例。对照组采用常规有创正压通气技术(IPPV),观察组采用NIPPV通气支持。比较两组患者临床指标、生命体征、血浆N端脑利钠肽前体(NT-pro BNP)、肺部感染与健康状况。结果观察组重症监护时间、总机械通气时间与有创通气时间均短于对照组,差异有统计学意义(P<0.05)。观察组患者再插管率为3.33%(2/60),呼吸机相关性肺炎(VAP)发生率为3.33%(2/60),对照组再插管率为15.00%(9/60),VAP发生率为16.67%(10/60),两组比较差异有统计学意义(P<0.05)。观察组患者心率(HR)、呼吸频率(RR)、血二氧化碳分压(PaCO_2)水平均低于对照组,p H与血氧分压(PaO_2)水平高于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者血浆NT-pro BNP水平、肺临床感染评分(CPIS)与急性生理与慢性健康评分(APACHE-Ⅱ)比较,差异无统计学意义(P>0.05)。治疗后,观察组患者血浆NT-pro BNP水平、CPIS与APACHE-Ⅱ评分均低于对照组,差异有统计学意义(P<0.05)。结论针对AECOPD合并呼吸衰竭患者,采用NIPPV治疗利于缩短通气治疗时间,改善患者生命体征,降低肺部感染风险,维护患者健康状态,增强临床疗效。Objective To explore the clinical value of noninvasive ventilation sequential （NIPPV） in the treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） combined with respiratory failure.Methods One hundred and twenty patients with AECOPD complicated with respiratory failure treated in the First People＇s Hospital of Huzhou City from July 2015 to July 2017 were selected and they were divided into two groups by random number table,with 60 cases in each group.The control group received conventional invasive positive pressure ventilation （IPPV） and the observation group received NIPPV support.Clinical indicators,vital signs,N-terminal pro-brain natriuretic peptide （NT-proBNP）,pulmonary infection and health status were compared between the two groups.Results The durations of intensive care,total duration of mechanical ventilation and invasive ventilation in the observation group were all shorter than those in control group,with statistically significant differences （P 〈 0.05）.In observation group,the re-intubation rate was 3.33% （2/60） and the incidence of ventilator-associated pneumonia （VAP） was 3.33% （2/60）,while in the control group,the re-intubation rate was 15.00% （9/60） and the incidence of VAP was 16.67% （10/60）,the differences between the two groups were statistically significant （P 〈 0.05）.The levels of heart rate （HR）,respiratory rate （RR） and partial pressure of carbon dioxide （PaCO2） in the observation group were lower than those in the control group,and the levels of pH and partial pressure of blood oxygen （PaO2） were higher than those in the control group （P 〈 0.05）.Before treatment,the levels of NT-proBNP,clinical pulmonary infection score （CPIS） and acute physiology and chronic health evaluation （APACHE-Ⅱ） scores of lung infection in the two groups showed no significant differences （P 〉 0.05）.After treatment,the levels of NT-proBNP,CPIS and APACHE-Ⅱ scores in the observation group were lower

关 键 词：感染 呼吸衰竭 无创通气序贯治疗 有创正压通气技术 生命体征 

分 类 号：R563.9[医药卫生—呼吸系统]