双相呼吸道正压通气呼吸机参数对AECOPD患者胸肺顺应性及动脉血气指标影响  

Effects of parameters of BiPAP ventilator on compliances of chest and lung,and arterial blood gas indexes of AECOPD patients

作　　者：刘晓霞 孙娟 米拉瓦·牙生 Liu Xiaoxia;Sun Juan;Milawa Yasheng(CCU of Xinjiang Cardiovascular and Cerebrovascular Hospital,Urumqi 830011,China)

机构地区：[1]新疆心脑血管病医院CCU,乌鲁木齐830011

出　　处：《中国医学装备》2024年第1期114-118,共5页China Medical Equipment

基　　金：新疆维吾尔自治区自然科学基金(20210116)。

摘　　要：目的:探讨双相呼吸道正压(BiPAP)通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)患者时呼吸机参数对其胸肺顺应性及动脉血气指标的影响。方法:选取2020年4月至2021年4月新疆心脑血管病医院收治的行BiPAP呼吸机无创通气治疗的AECOPD患者78例,吸气相正压(IPAP)的常用范围为10~25 cmH_(2)O。根据患者的具体情况和临床需求调整参数,将78例患者中IPAP<15 cmH_(2)O纳入低IPAP组(34例),≥15 cmH_(2)O纳入高IPAP组(44例),分析BiPAP呼吸机参数IPAP与患者治疗效果、胸肺顺应性及动脉血气指标的相关性。结果:高IPAP组患者治疗有效率为93.48%,显著高于低IPAP组的71.88%,两组比较差异有统计学意义(x^(2)=6.766,P<0.05);治疗前,两组间胸廓顺应性(CTh)、肺顺应性(CL)及总顺应性(Ct)等指标差异均无统计学意义(P>0.05);治疗后,高IPAP组患者Ct、CL和CTh均明显高于低IPAP组,两组比较差异有统计学意义(t=2.508、2.027、2.185,P<0.05)。上呼吸机前两组动脉血氧分压(PaO_(2))值比较差异均无统计学意义(P>0.05),上呼吸机2、4、6和8 h时高IPAP组患者PaO2值均显著高于低IPAP组,差异有统计学意义(t=8.531、5.296、3.264、4.623,P<0.05)。两组患者炎性介质中基质金属蛋白酶9(MMP-9)和白细胞介素-8(IL-8)发病时均显著升高,经治疗后该两种介质水平均有所下降,且高IPAP组显著低于低IPAP组,其差异有统计学意义(t=2.251、5.484,P<0.05)。高IPAP组患者腹胀发生率为20.45%,显著高于低IPAP组的5.88%,组间差异有统计学意义(x^(2)=3.623,P<0.05)。结论:BiPAP呼吸机参数中的IPAP对AECOPD患者胸肺顺应性、动脉血气分析、炎性指标均有影响,高IPAP能提高患者治疗有效性,改善胸肺顺应性及动脉血气分析,但是易造成腹胀等不良反应。Objective:To explore the effects of ventilator parameters on the compliances of chest and lung,and arterial blood gas indicators of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)when biphasic positive airway pressure(BiPAP)ventilation treated AECOPD patients at acute exacerbation period.Method:A total of 78 AECOPD patients who underwent non-invasive ventilation treatment by using BiPAP ventilators in Xinjiang Cardiovascular and Cerebrovascular Hospital from April 2020 to April 2021 were selected.The common range of inspiratory positive airway pressure(IPAP)was 10-25 cmH_(2)O.Based on the specific situation and adjustment of clinical needs of patients,this study set“<15 cmH_(2)O”as the low IPAP group(n=34),and set“≥15 cmH_(2)O”as the high IPAP group(n=44)to analyze the correlation between IPAP of BiPAP ventilator parameters and the therapeutic effects,chest lung compliances and arterial blood gas indicators of patients.Results:The rate of therapeutic effect of patients in the high IPAP group was 93.48%,which was significantly higher than 71.88%of the low IPAP group,and the difference between the two groups was statistically significant(x^(2)=6.766,P<0.05).Before treatment,there were no statistically significant differences in indicators included chest compliance(CTh),lung compliance(CL)and total compliance(Ct)between the two groups(P>0.05).After treatment,the Ct,CL and CTh of patients in the high IPAP group were significantly higher than those in the low IPAP group,and the differences between the two groups were statistically significant(t=2.508,2.027,2.185,P<0.05),respectively.There was no statistically significant difference in arterial oxygen partial pressure(PaO2)value between the two groups before used mechanical ventilation(P>0.05).The PaO2 values of patients at 2,4,6 and 8h of using mechanical ventilation in the high IPAP group were significantly higher than those in the low IPAP group,and the differences between different groups were statistically significant(t=

关 键 词：慢性阻塞性肺疾病急性加重期(AECOPD) 双相呼吸道正压通气(BiPAP) 呼吸机 胸肺顺应性 动脉血气指标 

分 类 号：R197.39[医药卫生—卫生事业管理]