头罩无创通气在慢性阻塞性肺疾病急性加重合并呼吸衰竭患者中的应用  

Non-invasive ventilation with helmet in patients with respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease

作　　者：刘奇[1] 陆欢 单梦田 王伟[2] 朱长举[1] 陈荣昌 张昭[4] 兰超[1] Liu Qi;Lu Huan;Shan Mengtian;Wang Wei;Zhu Changju;Chen Rongchang;Zhang Zhao;Lan Chao(Department of Emergency Medicine,the First Affiliated Hospital of Zhengzhou University,Open Laboratory of Key Subjects of Clinical Medicine in Colleges and Universities of Henan Province of China,Zhengzhou 450052,Henan,China;Department of Clinical Evaluation,Henan Medical Association,Zhengzhou 450003,Henan,China;Shenzhen Institute of Respiratory Diseases,Department of Respiratory and Critical Medicine,Shenzhen People's Hospital,Shenzhen 518020,Guangdong,China;Department of Respiratory and Critical Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan,China)

机构地区：[1]郑州大学第一附属医院急诊科,河南省高等学校临床医学重点学科开放实验室,450052 [2]河南省医学会临床评估科,郑州450003 [3]深圳呼吸疾病研究所,深圳市人民医院呼吸与重症科,518020 [4]郑州大学第一附属医院呼吸与重症二科,450052

出　　处：《中华危重病急救医学》2020年第1期14-19,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金青年基金(81400051);河南省高等学校重点科研项目(19A320073)。

摘　　要：目的探讨头罩无创通气(NIV)治疗慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者的效果及耐受性,对改善血气、缓解呼吸困难等方面的作用以及并发症的发生情况。方法选择2018年1月1日至2019年5月31日郑州大学第一附属医院急诊重症监护病房(EICU)和呼吸重症监护病房(RICU)收治的AECOPD合并呼吸衰竭患者。在获得患者或其授权家属知情同意后,采用随机数字表法分为头罩组和面罩组,分别利用头罩或面罩按计划进行NIV。于NIV过程中(NIV即刻、1 h、4 h和结束时)监测患者耐受性评分、血气分析、心率(HR)、呼吸频率(RR),并观察气管插管、住院死亡及并发症等终点指标。绘制Kaplan-Meier生存曲线,分析两组患者30 d生存情况。结果研究期间共收治AECOPD合并呼吸衰竭患者82例,排除氧合指数(PaO2/FiO2)>200 mmHg(1 mmHg=0.133 kPa)、带气管插管转入或达到有创通气指征、合并急性心肌梗死、2周内发生严重创伤、分泌物过多及排痰障碍或拒绝参加本研究者,最终共26例纳入分析,被随机分配至头罩组和面罩组,每组13例。两组NIV各时间点PaO2/FiO2均较NIV即刻显著升高,两组间比较差异无统计学意义;但NIV结束时头罩组PaO2/FiO2较NIV即刻的增加值显著高于面罩组(mmHg:75.1±73.2比7.7±86.0,P<0.05)。两组NIV各时间点RR均较NIV即刻降低,以头罩组降低更为显著,NIV 1 h、4 h和结束时与面罩组比较差异均有统计学意义(次/min:1 h为17.5±4.1比23.1±6.3,4 h为16.2±2.5比20.0±5.5,结束时为15.5±2.5比21.2±5.9,均P<0.05)。头罩组NIV 4 h和结束时耐受性评分显著高于面罩组(分:4 h为3.9±0.3比3.3±0.9,结束时为3.8±0.6比2.9±0.9,均P<0.05)。头罩组在改善pH值、动脉血二氧化碳分压(PaCO2)、HR等方面与面罩组比较差异均无统计学意义。头罩组并发症的总发生数及鼻梁皮损数均明显少于面罩组〔总数(例):3比8,鼻梁皮损数(例):0比4,均P<0.05〕。�Objective To investigate the effect and tolerance of non-invasive ventilation(NIV)with helmet in patients with respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and the effect on improving blood gas,alleviating dyspnea and the occurrence of complications.Methods Patients with AECOPD and respiratory failure admitted to emergency intensive care unit(EICU)and respiratory intensive care unit(RICU)of the First Affiliated Hospital of Zhengzhou University from January 1st,2018 to May 31st,2019 were enrolled.After obtaining the informed consent of the patients or their authorized family members,the patients were divided into two groups:the helmet group and the facial mask group by random number table.NIV was carried out by using helmet or facial mask,respectively.During the course of NIV(immediately,1 hour,4 hours and at the end of NIV),the tolerance score,blood gas analysis,heart rate(HR),respiratory rate(RR)of patients were monitored,and the incidence of tracheal intubation,in-hospital mortality and complications were observed.Kaplan-Meier survival curve was plotted to analyze the 30-day cumulative survival of the two groups.Results A total of 82 patients with AECOPD and respiratory failure were included during the study period.After excluding patients with the oxygenation index(PaO2/FiO2)>200 mmHg(1 mmHg=0.133 kPa),with tracheal intubation or invasive ventilation,suffering from acute myocardial infarction,severe trauma within 2 weeks,excessive secretion,sputum discharge disorder or refusal to participate in the study,26 patients were finally enrolled in the analysis,randomly assigned to the helmet group and the facial mask group,with 13 patients in each group.The PaO2/FiO2 after NIV of patients in both groups was increased significantly as compared with that immediately after NIV,without significant difference between the two groups,but the increase in PaO2/FiO2 at the end of NIV compared with immediately after NIV in the helmet group was significantly higher than that in

关 键 词：头罩 无创通气 慢性阻塞性肺疾病急性加重 呼吸衰竭 

分 类 号：R563.9[医药卫生—呼吸系统] R563.8[医药卫生—内科学]