全科-专科医生联合管理家庭无创通气在慢性阻塞性肺疾病患者中的应用效果观察  

General practitioners-specialists jointly manage family noninvasive ventilation in patients with chronic obstructive pulmonary disease

作　　者：曹婷婷[1] 万俊 冯永海[2] 楚荷莹[3] Cao Tingting;Wan Jun;Feng Yonghai;Chu Heying(Department of General Medicine,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Respiratory and Critical Diseases,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;First Department of Respiratory and Critical Diseases,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院全科医学科,450052 [2]郑州大学第五附属医院呼吸与危重症学科,450052 [3]郑州大学第一附属医院呼吸与危重症1科,450052

出　　处：《中国实用医刊》2020年第14期10-13,共4页Chinese Journal of Practical Medicine

基　　金：河南省高等学校重点科研项目(19A320065)。

摘　　要：目的:探讨全科-专科医生联合管理家庭无创通气在慢性阻塞性肺疾病(COPD)患者中的应用效果。方法:抽取郑州大学第五附属医院2017年12月至2018年12月确诊为COPD合并呼吸衰竭稳定期患者64例,采用电脑盲选法将其分为家庭无创呼吸机通气组(观察组)和自然病程对照组(对照组),每组32例。全科医生与呼吸专科医生每3个月随访患者1次,了解患者情况,共同研讨患者呼吸机参数,指导患者应用,并动态监测患者肺功能指标如第1秒用力呼气容积占预计值百分比(FEV1%pred)、血气分析指标如pH值、脉搏血氧饱和度(SpO 2)、动脉血氧分压(PaO 2)、动脉血二氧化碳分压(PaCO 2)、改良英国医学研究委员会呼吸困难问卷分级(mMRC分级),及1年内病情急性加重次数。观察时间为1年,采用SPSS 22.0统计学软件分析两组患者相关数据。结果:观察组患者治疗1年后SpO 2、PaO 2及mMRC分级较对照组有改善,差异有统计学意义(P<0.05);急性发作次数较对照组减少,差异有统计学意义(P<0.05),但FEV1%pred、PaCO 2、pH值比较差异未见统计学意义(P>0.05)。结论:全科-专科医生联合管理家庭无创通气能够显著提高COPD患者动脉血氧分压,改善患者呼吸困难程度,减少急性发病次数。Objective To explore the effect of non-invasive ventilation in patients with chronic obstructive pulmonary disease(COPD)managed by general practitioners and specialists.Methods A total of 64 patients with COPD and respiratory failure in stable period in the Fifth Affiliated Hospital of Zhengzhou University from December 2017 to December 2018 were selected and randomly divided into two groups by computer blind selection method:the family non-invasive ventilator ventilation group(observation group)and the natural course control group(control group),with 32 cases in each group.The patients were followed up by general practitioners and respiratory specialists once every three months and understood the situation of patients,discussed the parameters of ventilator,guided the application of ventilator,and monitored the pulmonary function indexes dynamically such as forced expiratory volume per second(FEV1%pred),blood gas analysis indexes such as blood gas analysis indicators pH value,pulse oxygen saturation(SpO2),arterial oxygen sub-pressure(PaO2),arterial blood carbon dioxide sub-pressure(PaCO2),modified British Medical Research Council(mMRC)dyspnea scales,and the number of acute exacerbations within 1 year.Results After 1 year of treatment,SpO2,PaO2 and mMRC scales were improved compared with the control group,with statistically significant differences(P<0.05),and the number of acute seizures decreased compared with the control group,and the difference was statistically significant(P<0.05),but there was no significant difference in FEV1%pred,PaCO2 and pH value(P>0.05).Conclusions The combination of general practitioners and specialists in the management of noninvasive ventilation at home can significantly improve the arterial oxygen partial pressure of COPD patients,improve the degree of dyspnea and reduce the number of acute cases.

关 键 词：慢性阻塞性肺疾病 家庭无创通气 全科医生 专科医生 

分 类 号：R563.9[医药卫生—呼吸系统]