呼吸训练联合无创呼吸机对AECOPD合并呼吸衰竭患者呼吸功能和预后的影响分析  

Effect of respiratory training combined with non-invasive ventilator on respiratory function and clinical prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure

作　　者：张颖[1] 王爱萍[1] ZHANG Ying;WANG Ai-ping(Department of Emergency,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院急诊科

出　　处：《中国医学前沿杂志（电子版）》2019年第11期110-114,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的分析呼吸训练联合无创呼吸机对慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并呼吸衰竭患者呼吸功能和预后的影响。方法选取本院2016年3月至2017年3月收治的120例AECOPD合并Ⅱ型呼吸衰竭患者为研究对象。采用随机数表法将入选患者分为观察组和对照组,每组各60例,均给予综合对症治疗和无创呼吸机治疗,观察组患者在此基础上接受呼吸训练。比较两组患者治疗前后血气指标、呼吸功能、急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、辅助呼吸肌评分,并评价患者预后、日常生活活动能力和生活质量。结果两组患者治疗后动脉血pH、动脉血氧分压(arterial partial pressure of oxygen,PaO2)、动脉血氧饱和度(arterial oxygen saturation,SaO2)均显著高于本组治疗前(均P<0.05),动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO2)均显著低于本组治疗前(均P<0.05)。治疗后24 h和72 h,观察组患者pH、PaO2、SaO2均显著高于同期对照组(均P<0.05),PaCO2均显著低于同期对照组(均P<0.05)。两组患者治疗后1周第1秒用力呼气容积(forced expiratory volume in one second,FEV1)、FEV1与用力肺活量(forced vital capacity,FVC)比值(FEV1/FVC)、FEV1%预测值均显著高于本组治疗前(均P<0.05),APACHEⅡ评分、辅助呼吸肌评分均显著低于本组治疗前(均P<0.05)。治疗后1周,观察组患者FEV1、FEV1/FVC、FEV1%预测值均显著高于对照组(均P<0.05),APACHEⅡ评分、辅助呼吸肌评分均显著低于对照组(均P<0.05)。观察组患者住院天数、插管率均显著低于对照组(均P<0.05),两组患者病死率比较差异无统计学意义(P>0.05)。剔除病死患者后结果显示,两组患者治疗后功能独立性评定量表(functional independence measure,FIM)评分和世界卫生组织生活质量测定量表简表(brief version of WHO Objective To explore the effect of respiratory training combined with non-invasive ventilator on respiratory function and clinical prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure.Method 120 AECOPD patients with typeⅡ respiratory failure admitted to our hospital from March 2016 to March 2017 were included in this case-control study.They were divided into observation group and control group by random number table method,60 cases in each group.All patients were given symptomatic treatment and non-invasive ventilator treatment.Observation group patients were given respiratory training.The changes of blood gas index,respiratory function,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and auxiliary respiratory muscle score before and after treatment were comp ared between the two groups,and the prognosis,activities of daily living and quality of life were evaluated.Result The arterial blood pH,arterial partial pressnre of oxygen(PaO2)and arterial oxygen saturation(SaO2)of the two groups after treatment were significantly higher than those before treatment(all P<0.05),and the arterial patial pressure of carbon dioxide(PaO2)of the two groups were significantly lower than those before treatment(all P<0.05).At 24 h and 72 h after treatment,the arterial blood pH,PaO2 and SaO2 in observation group were significantly higher than those in control group(all P<0.05),and PaCO2 were significantly lower than those in control group(all P<0.05).The forced expiratory volume in one second(FEV1),FEV1 to forced vital capacity(FVC)ratio(FEV1/FVC),FEV1%predictive value of the two groups were significantly higher than those before treatment(all P<0.05),APACHEⅡ score and auxiliary respiratory muscle score were significantly lower than those of the group before treatment(all P<0.05).1 week after treatment,FEV1,FEV1/FVC,FEV1%predictive value in observation group were significantly higher than those in control group(all P<0.05),APACHEⅡ sco

关 键 词：呼吸训练 无创呼吸机 慢性阻塞性肺疾病急性加重期 慢性呼吸衰竭 

分 类 号：R56[医药卫生—呼吸系统]