不同压力水平家庭无创通气对慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的疗效  

Efficacy of high-intensity non-invasive ventilation in stable chronic obstructive pulmonary disease patients with type Ⅱ respiratory failure

作　　者：魏凯凡 赵禹 李秀 WEI Kaifan;ZHAO Yu;LI Xiu(Department of Respiratory and Intensive Care Unit,Third Affiliated Hospital of Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽医科大学第三附属医院呼吸与危重症医学科,合肥230001

出　　处：《临床与病理杂志》2020年第8期2044-2049,共6页Journal of Clinical and Pathological Research

摘　　要：目的:研究不同压力水平家庭无创通气对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并Ⅱ型呼吸衰竭的疗效。方法:选取2017年9月至2018年9月因COPD急性加重在安徽医科大学第三附属医院呼吸与危重症医学科住院,通过无创通气治疗后病情平稳仍伴有Ⅱ型呼吸衰竭的45例患者,根据患者可耐受家庭无创呼吸机吸气压力(invasive ventilator inspiratory pressure,IPAP)水平,分为高压力无创通气组(高压力组;IPAP≥18 cmH2O;n=28)和低压力无创通气组(低压力组;IPAP<18 cmH2O;n=17)。比较治疗1年后两组患者的疗效。结果:无创呼吸机治疗前后比较:治疗后两组患者的总住院次数、总住院天数和改良英国医学研究学会呼吸困难指数(modified British medical research council,mMRC)评分均低于治疗前,差异有统计学意义(均P<0.05);高压力组治疗后PaCO2和COPD评估测试(COPD assessment test,CAT)较治疗前改善明显,差异有统计学意义(P<0.05),但低压组治疗后PaCO2和CAT评分较治疗前改善不明显(P>0.05)。无创呼吸机治疗后比较:高压力组较低压力组在改善PaCO2、CAT评分、mMRC评分,减少总住院次数和总住院天数方面均有统计学意义(P<0.05)。结论:高压力家庭无创通气对COPD合并Ⅱ型呼吸衰竭的疗效优于低压力组,在临床上,若患者可耐受高压力水平无创通气,应推荐使用。Objective:To study the efficacy of high-intensity non-invasive ventilation in stable chronic obstructive pulmonary disease patients with type Ⅱ respiratory failure.Methods:Forty-five patients with chronic obstructive pulmonary exacerbation and type Ⅱ respiratory failure in our department from September 2017 to September 2018 were selected,after treatment,the disease was still stable with carbon dioxide retention.According to the setting level of non-invasive ventilator inspiratory pressure(IPAP),it is divided into high-intensity non-invasive ventilation(IPAP≥18 cmH2O)and low-intensity non-invasive ventilation group(IPAP<18 cmH2O).Among them,28 people in high-intensity group and 17 people in the low-intensity group.Before and after treatment for 1 year,the efficacy in the two groups were compared.Results:After treatment,the two groups of hospitalizations,hospitalization days and modified British medical research council(mMRC)compared with before treatment,the differences were statistically significant(P<0.05),PaCO2 and COPD assessment test(CAT)scores in the high-intensity group were statistically significant(P<0.05),but not statistically significant in the low-intensity group(P>0.05).There were significant differences in the improvement of PaCO2,CAT scores,mMRC,reduction of hospitalizations and hospitalization days compared high-intensity group with low-intensity group(P<0.05).Conclusion:High-intensity non-invasive ventilation in patients with stable chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure is better than low-intensity group.Clinically,if patients can tolerate high-pressure levels of non-invasive ventilation,it should be recommended.

关 键 词：家庭无创通气 压力水平 慢性阻塞性肺疾病 Ⅱ型呼吸衰竭 

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