平均容量保证型压力支持无创通气在慢性阻塞性肺疾病伴CO2潴留患者急诊中的应用价值  

Application value of average volume assured pressure support non-invasive ventilation mode in treatment of chronic obstructive pulmonary disease with CO retention in emergency setting

作　　者：陈之力 周觉 陈玉熹 龚昌要 陈清 CHEN Zhili;ZHOU Jue;CHEN Yuxi;GONG Changyao;GHEN Qing(Emergency Department,Wenzhou Central Hospital,Wenzhou 325000,China)

机构地区：[1]温州市中心医院急诊科,325000

出　　处：《浙江医学》2020年第14期1511-1514,1519,共5页Zhejiang Medical Journal

摘　　要：目的探讨平均容量保证型压力支持(AVAPS)无创通气在慢性阻塞性肺疾病(COPD)伴CO2潴留患者急诊中的应用价值。方法选择2018年3月至2019年4月温州市中心医院于急诊抢救的COPD伴CO2潴留患者166例,分为观察组、对照组各83例。其中,观察组接受AVAPS无创通气治疗,对照组接受同步/时间(S/T)无创通气治疗。比较两组患者治疗前后呼吸机参数调节次数与不良反应、血气指标、肺功能指标、焦虑抑郁心理评分、无创通气时间、住院时间等情况。结果观察组患者无创通气治疗期间呼吸机参数调节次数、发生人机对抗、腹胀、胸闷憋气感明显少于对照组,差异均有统计学意义(均P<0.05)。观察组治疗24 h后PaCO2水平明显低于对照组,第一秒用力呼气容积、一秒用力呼气量占用力肺活量比值指标水平均明显高于对照组,治疗3 d后焦虑、抑郁评分明显低于对照组,无创通气时间、住院时间均明显短于对照组,差异均有统计学意义(均P<0.05)。结论AVAPS无创通气用于急诊抢救COPD伴CO2潴留患者的效果显著,相较于S/T无创通气更有助于改善患者的不良情绪,减少人工呼吸机参数调节次数,降低PaCO2水平及不良反应发生。Objective To explore the application value of average volume assured pressure support(AVAPS) non-invasive ventilation mode in the treatment of chronic obstructive pulmonary disease(COPD) with CO2 retention in emergency setting.Methods A total of 166 COPD patients with CO2 retention treated in emergency department from March 2018 to April 2019 were divided into two groups with 83 cases in each. Patients in study group received AVAPS non-invasive ventilation, and those in the control group received simultaneous/time(S/T) non-invasive ventilation. The number of ventilator parameter adjustments, adverse reactions, blood gas indexes, lung function indexes, anxiety and depression psychological scores, non-invasive ventilation time,and length of hospital stay were compared between the two groups. Results The number of ventilator parameter adjustments,the occurrence of man-machine confrontation, abdominal distension, and chest tightness in the study group during noninvasive ventilation treatment were significantly less than those in the control group(P<0.05). After 24 hours of treatment, the PaCO2 level was significantly lower than that of the control group, and the FEV1, FEV1/FVC indicators were significantly higher than the control group. After 3 days of treatment, the anxiety and depression scores in study group were significantly lower than those of the control group. The non-invasive ventilation time and length of hospital stay of study group were significantly shorter than the those of control group(both P<0.05). Conclusion AVAPS non-invasive ventilation mode is feasible in treatment of COPD patients with CO2 retention in emergency setting. Compared with S/T non-invasive ventilation mode, it is more effective to reduce the number of artificial ventilator parameter adjustments, decrease PaCO2 levels and adverse reactions, as well as improve psychological stress of patients.

关 键 词：平均容量保证型压力支持无创通气 同步/时间无创通气 COPD CO2潴留 

分 类 号：R563.9[医药卫生—呼吸系统]