不同雾化吸入方法对慢性阻塞性肺疾病急性加重无创通气治疗的效果评价  

Effect of different nebulization methods in acute exacerbations of chronic obstructive pulmonary disease requiring non-invasive ventilation

作　　者：杨燕[1] 姚莉[1] 万文霞[1] 贾小英[1] 凌楠[1] YANG Yan;YAO Li;WAN Wenxia;JIA Xiaoying;LING Nan(Department of Respiratory and Critical Care Medicine,Changzhou First People's Hospital,Changzhou,Jiangsu 213000,P.R.China)

机构地区：[1]常州市第一人民医院呼吸与危重症医学科,江苏常州213000

出　　处：《中国呼吸与危重监护杂志》2023年第9期615-623,共9页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的通过对三种不同雾化吸入方法作对比,分析不同雾化吸入方法对使用无创机械通气(noninvasive mechanical ventilation,NIV)治疗的慢性阻塞性肺疾病(简称慢阻肺)急性加重患者的安全性和有效性。方法运用随机对照试验设计的方法,根据纳入标准和排除标准选取入住于常州市第一人民医院呼吸与危重症医学科的慢阻肺急性加重患者102例,根据随机数字表法随机分为对照组、试验一组、试验二组。对照组采用NIV间歇期氧气驱动雾化治疗,试验一组采用NIV同时氧气驱动雾化治疗,试验二组采用NIV同时空气驱动雾化治疗,三组无创呼吸机设置和雾化治疗方案均保持一致。比较三种雾化吸入方法的经皮二氧化碳分压(transcutaneous carbon dioxide pressure,PtCO_(2))的动态波动,动脉血气指标(PaCO_(2)、PaO_(2)、pH),生命体征及脉搏血氧饱和度异常波动次数。结果对照组、试验一组雾化15 min的PtCO_(2)水平均高于试验二组(P<0.05),组内比较显示对照组雾化15 min PtCO_(2)高于其他时间点PtCO_(2)(P<0.05)。试验一组各时间点PtCO_(2)总体无显著差异(P>0.05),试验二组各测量时间点PtCO_(2)随测量时间逐渐降低(P<0.05),试验二组雾化前后的PtCO_(2)差值(ΔPtCO_(2))较对照组和试验一组大(P<0.05)。试验二组雾化结束0 min、5 min PtCO_(2)均低于对照组和试验一组(P<0.05),雾化结束10 min、15 min PtCO_(2)三组间无显著差异(P>0.05)。对照组各时间点PtCO_(2)除雾化结束10 min与雾化结束15 min无显著差异(P>0.05),其余时间点PtCO_(2)均随测量时间降低(P<0.05)。试验一组任意两个时间点PtCO_(2)均有显著差异,随测量时间降低(P<0.05);试验二组雾化结束5 min PtCO_(2)较雾化结束0 min低(P<0.05),其余时间点均无显著差异(P>0.05)。对照组治疗前PaCO_(2)和pH值最早与治疗第4天PaCO_(2)和pH有显著差异(P<0.01);试验一组、试验二组治疗前PaCO_(2)与其余时间点均有显著差Objective To analyze the effect of different nebulization methods in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)requiring non-invasive ventilators(NIV).Methods One hundred and two patients with AECOPD were selected according to the standard,and randomly divided into a control group,a trial group I,and a trial group II according to the random number table.The patients in the control group received NIV intermittent oxygen-driven nebulization;the patients in the trial group I received NIV simultaneous oxygen-driven nebulization;and the patients in the trial group II received NIV simultaneous air-driven nebulization.The dynamic fluctuations of transcutaneous partial pressure of carbon dioxide(PtCO_(2)),arterial blood gas indexes(PaCO_(2),PaO_(2),pH),vital signs and pulse oxygen saturation(SpO_(2))fluctuations were compared.Results PtCO_(2)at 15min of nebulization in the trial group II were lower than the other groups(P<0.05).PtCO_(2)at 15min of nebulization was higher than the other time points in the control group(P<0.05);there was no statistical difference of PtCO_(2)at different time points in the trial group I(P>0.05);PtCO_(2)gradually decreased with time in the trial group II(P<0.05).The difference before and after nebulization of PtCO_(2)(dPtCO_(2))was larger in trial group II than the other groups(P<0.05).PtCO_(2)at 0min and 5min after the end of nebulization in trial group II were lower than the other groups(P<0.05);there were no statistical differences of PtCO_(2)at 10min and 15min after the end of nebulization among three groups(P>0.05).There were statistical differences of the PtCO_(2)at each time point in the control group except for the PtCO_(2)at 10 min and 15min after the end of nebulization,all of which decreased with time;PtCO_(2)at each time points of nebulization decreased with time in the trial group I(P<0.05).PtCO_(2)only at 5min after the end of nebulization was lower than that at 0min after the end of nebulization in trial group II(P<0.05),there were no sta

关 键 词：慢性阻塞性肺疾病急性加重 雾化吸入 氧气驱动雾化 空气驱动雾化 经皮二氧化碳分压 无创机械通气 

分 类 号：R563.9[医药卫生—呼吸系统]