无创呼吸机联合体外膈肌起搏器对慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者的临床疗效观察  

Clinical effect of noninvasive ventilator combined with external diaphragm pacemaker on patients with acute exacerbation of chronic obstructive pulmonary disease complicated with typeⅡrespiratory failure

作　　者：易小莉 甄新现 李仕雄 YI Xiao-li;ZHEN Xin-xian;LI Shi-xiong(Department of Respiratory Diseases,Taishan Hospital of Traditional Chinese Medicine,Taishan 529200,China)

机构地区：[1]广东省台山市中医院呼吸病科,529200

出　　处：《中国实用医药》2020年第28期10-12,共3页China Practical Medicine

基　　金：江门市科技计划项目(项目编号:2018020100160002855)。

摘　　要：目的探讨在慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者应用无创呼吸机联合体外膈肌起搏器治疗的临床疗效。方法72例慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者,随机分为对照组和研究组,各36例。对照组患者常规予以基础治疗,研究组患者在对照组基础上加用无创呼吸机联合体外膈肌起搏器治疗。比较两组患者治疗前后肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占用力肺活量比值(FEV1/FVC)、用力呼气时最高呼气流速(PEF)、用力呼出25%肺活量最大流速(FEF25)、用力呼出50%肺活量最大流速(FEF50)]、血气分析指标[动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、酸碱度(pH)及氧合指数(OI)]以及不良反应发生情况。结果治疗前,两组患者的FVC、FEV1、FEV1/FVC、PEF、FEF25、FEF50水平比较差异无统计学意义(P>0.05);治疗后,两组患者的FVC、FEV1、FEV1/FVC、PEF、FEF25、FEF50水平均较治疗前明显升高,且研究组患者FVC、FEV1、FEV1/FVC、PEF、FEF25、FEF50水平均显著优于对照组,差异具有统计学意义(P<0.05)。治疗前,两组患者的PaO2、PaCO2、pH、OI水平比较差异均无统计学意义(P>0.05);治疗后,两组患者的PaO2、PaCO2、pH、OI水平均较治疗前明显改善,且研究组患者的PaO2(56.94±10.26)mm Hg(1 mm Hg=0.133 kPa)、PaCO2(52.56±6.04)mm Hg、pH(7.40±0.05)、OI(239.43±19.82)mm Hg均显著优于对照组的(50.37±7.17)mm Hg、(63.46±5.82)mm Hg、(7.31±0.05)、(187.42±16.31)mm Hg,差异具有统计学意义(P<0.05)。两组的不良反应发生率比较差异无统计学意义(χ^2=0.107,P>0.05)。结论在慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者的治疗中应用无创呼吸机联合体外膈肌起搏器疗效确切,可明显改善患者的肺功能和血气指标,且不增加不良反应事件,临床应用价值较高。Objective To discuss the clinical efficacy of noninvasive ventilator combined with external diaphragm pacemaker on patients with acute exacerbation of chronic obstructive pulmonary disease complicated with typeⅡrespiratory failure.Methods A total of 72 patients with acute exacerbation of chronic obstructive pulmonary disease complicated with typeⅡrespiratory failure were randomly divided into control group and research group,with 36 cases in each group.The control group received conventional basic therapy,and the research group received noninvasive ventilator combined with external diaphragm pacemaker on the basis of the control group.The pulmonary function indicators[forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),FEV1/FVC,peak expiratory flow(PEF),forced expiratory flow rate at 25%of FVC(FEF25)and forced expiratory flow rate at 50%of FVC(FEF50)],blood gas analysis indexes[arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),pH and oxygenation index(OI)]before and after treatment and occurrence of adverse reactions were compared between the two groups.Results Before treatment,there was no statistically significant difference in FVC,FEV1,FEV1/FVC,PEF,FEF25 and FEF50 between the two groups(P>0.05).After treatment,FVC,FEV1,FEV1/FVC,PEF,FEF25 and FEF50 of the two groups were obviously higher than those before treatment,and those indexes of the research group were better than those of the control group,and the difference was statistically significant(P<0.05).Before treatment,there was no statistically significant difference in PaO2,PaCO2,pH and OI between the two groups(P>0.05).After treatment,PaO2,PaCO2,pH and OI of the two groups were obviously improved compared with those before treatment,and PaO2(56.94±10.26)mm Hg(1 mm Hg=0.133 kPa),PaCO2(52.56±6.04)mm Hg,pH(7.40±0.05)and OI(239.43±19.82)mm Hg of the research group were significantly better than(50.37±7.17)mm Hg,(63.46±5.82)mm Hg,(7.31±0.05)and(187.42±16.31)mm Hg of the control grou

关 键 词：无创呼吸机 体外膈肌起搏器 慢性阻塞性肺疾病急性加重期 Ⅱ型呼吸衰竭 肺康复 

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