不同雾化时机对无创通气治疗的慢性阻塞性肺疾病急性加重患者的效果比较  

Comparison of different atomizing inhalation times on noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：徐静娟[1] 杨燕[2] 刘艳[2] 姚莉[2] 万文霞[2] 凌楠[2] Xu Jingjuan;Yang Yan;Liu Yan;Yao Li;Wan Wenxia;Ling Nan(Outpatient Office,Changzhou First People′s Hospital,Changzhou 213000,China;Department of Respiratory and Critical Care Medicine,Changzhou First People′s Hospital,Changzhou 213000,China)

机构地区：[1]常州市第一人民医院门诊办公室,常州213000 [2]常州市第一人民医院呼吸与危重症医学科,常州213000

出　　处：《中国实用护理杂志》2024年第1期20-26,共7页Chinese Journal of Practical Nursing

摘　　要：目的对比无创间歇期雾化与无创同时雾化对慢性阻塞性肺疾病急性加重患者雾化过程中经皮二氧化碳分压(PtCO_(2))动态变化及治疗效果的影响。方法采用随机平行对照试验方法,便利抽样选取2021年10月至2022年9月常州市第一人民医院收治慢性阻塞性肺疾病急性加重患者70例,根据随机数字表法分为对照组和试验组各35例,对照组给予无创间歇期雾化吸入,试验组给予无创同时雾化吸入,观察2组雾化0、5、10、15 min(雾化结束点)的PtCO_(2)数值,记录每日的动脉血气分析指标(主要包括PaCO_(2)、PaO_(2)、pH),记录治疗前、治疗第4天、治疗第7天临床肺部感染评分和慢性阻塞性肺疾病患者自我评估评分。结果最终纳入对照组和试验组各33例患者。对照组男25例,女8例,年龄(75.33±8.24)岁;试验组男25例,女8例,年龄(72.39±8.56)岁。对照组患者雾化0、5、10、15 min PtCO_(2)数值分别为(63.83±12.47)、(64.40±12.57)、(65.42±13.77)、(66.62±14.59)mmHg(1 mmHg=0.133 kPa),各时间点PtCO_(2)之间总体上差异有统计学意义(F=8.05,P<0.01),进一步采用Sidak法两两比较显示雾化15 min与雾化0、5、10 min的PtCO_(2)差异均有统计学意义(均P<0.05),试验组雾化0、5、10、15 min PtCO_(2)数值分别为(67.62±11.89)、(67.15±12.12)、(67.82±12.22)、(68.15±12.09)mmHg,各时间点PtCO_(2)之间总体上差异无统计学意义(F=2.00,P>0.05);2组患者PaCO_(2)和pH值均随治疗时间好转,但对照组最早在治疗第4天开始与治疗前比较差异有统计学意义(P<0.05),而试验组在治疗第2天开始与治疗前比较差异有统计学意义(P<0.05)。结论2种雾化方式均取得良好的治疗效果,但无创同时雾化在雾化过程中更能维持PtCO_(2)的平稳,安全性更高,且能够更早改善患者动脉血气指标PaCO_(2)和pH值,是无创通气与雾化治疗联合运用尤其是患者伴有高碳酸血症时更宜选择的雾化方式。Objective To compare the dynamic changes of transcutaneous partial pressure of carbon dioxide(PtCO_(2))and treatment effect of non-invasive intermittent nebulization and non-invasive simultaneous nebulization in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods This was a randomized parallel controlled trial study.A total of 70 patients with acute exacerbation of COPD in Changzhou First People′s Hospital from October 2021 to September 2022 were selected by convenience sampling method,and divided into control group and experimental group by randomized digits table method with 35 cases in each group.The control group was given non-invasive intermittent oxygen-driven nebulization,and the experimental group was given non-invasive simultaneous oxygen-driven nebulization.The PtCO_(2)values at 0,5,10,15 min(the end point of atomization)of the 2 groups were observed,the daily arterial blood gas analysis indexes(mainly including PaCO_(2),PaO_(2)and pH)were recorded,and the clinical pulmonary infection score and the self-assessment score of COPD patients were recorded before treatment,on the 4th and 7th day of treatment.Results Finally,33 patients were included in both the control group and the experimental group.There were 25 males and 8 females in the control group,aged(75.33±8.24)years old.There were 25 males and 8 females in the experimental group,aged(72.39±8.56)years old.The PtCO_(2)values at 0,5,10,15 min in the control group were(63.83±12.47),(64.40±12.57),(65.42±13.77),(66.62±14.59)mmHg(1 mmHg=0.133 kPa).There were statistically significant differences in PtCO_(2)at all time points(F=8.05,P<0.01).Further pairwise comparison by Sidak method showed that there were statistically significant differences in PtCO_(2)at 15 min compared with 0,5,10 min(all P<0.05).The PtCO_(2)values at 0,5,10,15 min in the experimental group were(67.62±11.89),(67.15±12.12),(67.82±12.22),(68.15±12.09)mmHg.There was no statistically significant difference in PtCO_(2)at all time points(F=2.00

关 键 词：肺疾病 慢性阻塞性 无创机械通气 雾化吸入 经皮二氧化碳分压 

分 类 号：R563.9[医药卫生—呼吸系统]