急诊科慢性阻塞性肺疾病急性加重合并呼吸衰竭无创正压通气治疗时机的研究  

Optimal timing of noninvasive positive pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease with respiratory failure patients in emergency department

作　　者：张莹[1] 索旻[2] 甄雷[2] 张向群[1] 魏兵[1] 王晓[2] 刘禹庚[1] 曾红[1] Zhang Ying;Suo Min;Zhen Lei;Zhang Xiangqun;Wei Bing;Wang Xiao;Liu Yugeng;Zeng Hong(Department of Emergency, Western Hospital of Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043 , China;Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京朝阳医院西院急诊科,100043 [2]首都医科大学附属北京安贞医院急诊危重症中心,100029

出　　处：《中国医药》2019年第6期858-861,共4页China Medicine

基　　金：北京市医院管理局科研培育计划(PX2016048);北京市医院管理局青年人才培养“青苗”计划(QML20160605)~~

摘　　要：目的探讨无创正压通气(NPPV)在急诊科慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者中应用的时机。方法选取首都医科大学附属北京朝阳医院西院2015年10月至2019年1月急诊就诊的110例AECOPD合并呼吸衰竭患者,根据启动NPPV治疗的时机分为对照组(52例)和观察组(58例),观察组患者存在NPPV指征后即刻行NPPV治疗;对照组患者在发现存在NPPV指征后由于患者不愿配合、医疗条件限制等客观因素延迟行NPPV治疗。比较2组患者接受NPPV治疗2 h后临床表现、动脉血气指标、累计NPPV时间、气管插管率及病死率。结果与治疗前相比,2组治疗2 h后的动脉血氧分压及血氧饱和度均有明显改善(均P <0. 05)。观察组治疗后p H值(7. 37±0. 09比7. 28±0. 08)、动脉血二氧化碳分压(Pa CO2)[(67±14) mmHg(1 mmHg=0. 133 k Pa)比(82±19) mmHg]、碱剩余[10. 5(6. 9,14. 2) mmol/L比10. 2(5. 4,12. 9) mmol/L]、乳酸浓度[0. 8(0. 6,1. 3) mmol/L比1. 1(0. 7,1. 6) mmol/L]均优于治疗前(均P <0. 05)。观察组Δp H值和ΔPa CO2均明显高于对照组,差异均有统计学意义(均P <0. 001)。观察组的累计NPPV时间比对照组明显缩短[5. 0(2. 0,9. 3) d比6. 5(4. 0,9. 0) d],差异有统计学意义(P=0. 048)。对照组与观察组气管插管率[3. 8%(2/52)比0]与住院期间病死率[11. 5%(6/52)比3. 4%(2/58)]差异均无统计学意义(均P> 0. 05)。结论急诊科收治符合NPPV指征的AECOPD合并呼吸衰竭患者早期应用NPPV,可以有效纠正缺氧及高碳酸血症,缓解呼吸肌疲劳,改善临床症状,缩短无创通气治疗时间。Objective To investigate the optimal timing of noninvasive positive pressure ventilation(NPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with respiratory failure in emergency department. Methods A total of 110 AECOPD patients with respiratory failure admitted to Department of Emergency, Western Hospital of Beijing Chaoyang Hospital, Capital Medical University from October 2015 to January 2019 were enrolled. According to the timing of NPPV, the patients were divided into early application group(58 cases) and delayed application group(52 cases). Clinical data, arterial blood gas indexes before and 2 h after NPPV, duration time of NPPV, endotracheal intubation rate and fatality rate were analyzed. Results Arterial partial pressure of oxygen and oxygen saturation of blood were significantly improved 2 h after NPPV in both groups(both P<0.05). In observation group, pH value(7.37±0.09 vs 7.28±0.08), arterial partial pressure of carbon dioxide(PaCO2)[(67±14)mmHg vs (82±19)mmHg], buffuer excess[10.5(6.9,14.2)mmol/L vs 10.2(5.4,12.9)mmol/L] and lactic acid concentration[0.8(0.6,1.3)mmol/L vs 1.1(0.7,1.6)mmol/L] were significantly improved after NPPV(all P<0.05).ΔpH andΔPaCO2 in observation group were significantly higher than those in control group(both P<0.001). Duration time of NPPV in observation group was significantly shorter than that in control group[5.0(2.0,9.3)d vs 6.5(4.0,9.0)d](P=0.048). There was no difference of intubation rate[3.8%(2/52) vs 0] and in-hospital fatality rate[11.5%(6/52) vs 3.4%(2/58)] between control group and observation group. Conclusion Early application of NPPV in AECOPD patients with respiratory failure can effectively correct hypoxia and hypercarbia, ameliorate respiratory distress, improve clinical symptoms and shorten ventilation time.

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 无创正压通气 

分 类 号：R563[医药卫生—呼吸系统]