无创呼吸机加雾化对AECOPD并呼吸衰竭的治疗及预后观察
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摘要
目的:探讨无创呼吸机联合雾化吸入治疗对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭的临床疗效。方法:选取2017年2月-2019年2月本院收治的50例AECOPD合并呼吸衰竭患者。按照随机数字表法将其分为对照组和观察组,各25例。对照组采用无创呼吸机进行无创正压通气治疗,观察组在对照组基础上实施雾化吸入治疗,比较两组临床疗效、症状缓解时间、肺通气功能指标(FEV1、FEV1/FVC)、动脉血气分析指标(PaO_2、PaCO_2)、中转有创机械通气比例。结果:观察组总有效率为96.00%,高于对照组的76.00%(P<0.05);观察组咳嗽、咳痰、呼吸困难等症状缓解时间均短于对照组(P<0.05);治疗后,观察组FEV1、FEV1/FVC、PaO_2均高于对照组,PaCO_2低于对照组,比较差异均有统计学意义(P<0.05);观察组中转有创机械通气比例低于对照组(P<0.05)。结论:无创呼吸机联合雾化吸入治疗可有效缓解AECOPD合并呼吸衰竭患者的临床症状,改善其肺通气功能、动脉血气状况,有利于提高患者的临床疗效,避免患者因治疗无效而中转有创机械通气治疗。
Objective:To investigate the clinical effect of non-invasive ventilator and atomization on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with respiratory failure.Method:A total of50 AECOPD patients with respiratory failure from February 2017 to February 2019 in our hospital were selected.According to the random number table method,they were divided into control group and observation group,25 cases in each group.The control group was treated with non-invasive positive pressure ventilation by non-invasive ventilator,while observation group was treated with atomization inhalation on the basis of control group.The clinical efficacy,symptoms relief time,lung ventilation function index(FEV1,FEV1/FVC),arterial blood gas analysis index(PaO_2,PaCO_2)and the proportion of transitional invasive mechanical ventilation between two groups were compared.Result:The total effective rate of observation group was 96.00%,which was higher than 76.00% of control group(P<0.05).The relief time of cough,sputum and dyspnea in observation group were shorter than those of control group(P<0.05).After treatment,the levels of FEV1,FEV1/FVC and PaO_2 in observation group were higher than those of control group,and PaCO_2 was lower than that of control group,the differences were statistically significant(P<0.05).The conversion rate of invasive mechanical ventilation in observation group was lower than that of control group(P<0.05).Conclusion:Non-invasive ventilator combined with atomization inhalation therapy can effectively relieve the clinical symptoms of patients with AECOPD combined with respiratory failure,improve their pulmonary ventilation function and arterial blood gas status,and is conducive to improving the clinical efficacy of patients,so as to prevent patients from transferring to invasive mechanical ventilation treatment due to ineffective treatment.
Objective:To investigate the clinical effect of non-invasive ventilator and atomization on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with respiratory failure.Method:A total of50 AECOPD patients with respiratory failure from February 2017 to February 2019 in our hospital were selected.According to the random number table method,they were divided into control group and observation group,25 cases in each group.The control group was treated with non-invasive positive pressure ventilation by non-invasive ventilator,while observation group was treated with atomization inhalation on the basis of control group.The clinical efficacy,symptoms relief time,lung ventilation function index(FEV1,FEV1/FVC),arterial blood gas analysis index(PaO_2,PaCO_2)and the proportion of transitional invasive mechanical ventilation between two groups were compared.Result:The total effective rate of observation group was 96.00%,which was higher than 76.00% of control group(P<0.05).The relief time of cough,sputum and dyspnea in observation group were shorter than those of control group(P<0.05).After treatment,the levels of FEV1,FEV1/FVC and PaO_2 in observation group were higher than those of control group,and PaCO_2 was lower than that of control group,the differences were statistically significant(P<0.05).The conversion rate of invasive mechanical ventilation in observation group was lower than that of control group(P<0.05).Conclusion:Non-invasive ventilator combined with atomization inhalation therapy can effectively relieve the clinical symptoms of patients with AECOPD combined with respiratory failure,improve their pulmonary ventilation function and arterial blood gas status,and is conducive to improving the clinical efficacy of patients,so as to prevent patients from transferring to invasive mechanical ventilation treatment due to ineffective treatment.
引文
[1]S?rensen D,Frederiksen K,Groefte T,et al.Striving for habitual well-being in noninvasive ventilation:a grounded theory study of chronic obstructive pulmonary disease patients with acute respiratory failure[J].J Clin Nursing,2014,23(11-12):1726-1735.
[2]罗香香,刘少精,郑珊,等.无创正压通气联合氧气驱动雾化吸入治疗COPD合并呼吸衰竭患者的临床疗效观察[J].西部医学,2014,26(9):1249-1251,1254.
[3]Roca M,Verduri A,Corbetta L,et al.Mechanisms of acute exacerbation of respiratory symptoms in chronic obstructive pulmonary disease[J].Eur J Clin Invest,2013,43(5):510-521.
[4]沈贵洪,张治,许灿龙.纳洛酮与无创呼吸机联合治疗老年慢性阻塞性肺疾病并发呼吸衰竭的疗效[J].中国老年学杂志,2014,34(7):1827-1828.
[5]罗维贵,韦枫,梁琼,等.舒利迭联合无创通气治疗老年慢性阻塞性肺疾病呼吸衰竭患者的疗效[J].中国老年学杂志,2013,33(21):5332-5334.
[6]金玉女.无创呼吸机治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床疗效[J].中国老年学杂志,2014,34(21):6020-6022.
[7]刘璇.慢性阻塞性肺疾病合并呼吸衰竭应用无创呼吸机治疗的疗效观察[J].中国急救医学,2015,35(z2):280-281.
[8]赵微微,于湘春,顾泽鑫.无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的疗效及对肺功能和血清炎症因子水平的影响[J].中国老年学杂志,2017,37(17):4329-4331.
[9]蔡明文.无创呼吸机联合纳洛酮治疗老年COPD并发呼吸衰竭的临床疗效分析[J].临床肺科杂志,2013,18(3):474-475.
[10]潘淼,刘白絮.纳洛酮联合无创正压通气治疗中老年慢性阻塞性肺疾病伴呼吸衰竭的疗效[J].中国老年学杂志,2014,34(20):5728-5729.
[11]丁晓英,李雯.舒利迭联合无创通气治疗老年慢性阻塞性肺疾病呼吸衰竭的疗效[J].中国老年学杂志,2015,35(10):2823-2825.
[12]刘振宽,张宇.无创机械通气联合雾化吸入药物治疗AECOPD并发呼吸衰竭的临床观察[J].中国药房,2016,27(20):2833-2835.
[13]刘长志.无创通气联合噻托溴铵在老年慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭的临床应用[J].中国老年学杂志,2014,34(2):514-515.
[14]黄怀焕,林俊锋.噻托溴铵加用布地奈德福莫特罗粉吸入剂联合无创通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的效果[J].中国医药导报,2015,12(5):91-94.
[15]韦荣新,李虹.无创通气联合布地奈德福莫特罗粉吸入剂治疗重度慢性阻塞性肺疾病合并慢性呼吸衰竭效果观察[J].中国临床医生杂志,2018,46(9):1028-1030.
[16]王爽,郑秀艳,孙文华,等.异丙托溴铵与布地奈德对COPD合并Ⅱ型呼吸衰竭患者MDA,SOD,GSH-Px水平及肺功能的影响[J].现代生物医学进展,2015,15(33):6512-6515.
[17]张钰.复方异丙托溴铵治疗急性加重期慢性阻塞性肺疾病患者79例[J].中国老年学杂志,2013,33(16):4046-4047.
[18]贾娟.异丙托溴铵联合舒利迭雾化吸入治疗慢性阻塞性肺病并发呼吸衰竭62例[J].陕西医学杂志,2013,42(5):628-629.
[19]郑玉兰,曾宪升.氨溴索联合异丙托溴铵治疗慢性阻塞性肺疾病急性加重期的疗效分析[J].中华老年医学杂志,2014,33(11):1210-1211.
[20]张春美,丁震,裴翀,等.无创机械通气联合经管道雾化吸入布地奈德治疗AECOPD合并Ⅱ型呼吸衰竭的疗效[J].实用医学杂志,2015,31(5):819-820.
[21]蒋明彦,刘国平,刘中华,等.两种不同吸入方法治疗慢性阻塞性肺疾病合并呼吸衰竭效果的研究[J].临床肺科杂志,2016,21(9):1624-1627.
[2]罗香香,刘少精,郑珊,等.无创正压通气联合氧气驱动雾化吸入治疗COPD合并呼吸衰竭患者的临床疗效观察[J].西部医学,2014,26(9):1249-1251,1254.
[3]Roca M,Verduri A,Corbetta L,et al.Mechanisms of acute exacerbation of respiratory symptoms in chronic obstructive pulmonary disease[J].Eur J Clin Invest,2013,43(5):510-521.
[4]沈贵洪,张治,许灿龙.纳洛酮与无创呼吸机联合治疗老年慢性阻塞性肺疾病并发呼吸衰竭的疗效[J].中国老年学杂志,2014,34(7):1827-1828.
[5]罗维贵,韦枫,梁琼,等.舒利迭联合无创通气治疗老年慢性阻塞性肺疾病呼吸衰竭患者的疗效[J].中国老年学杂志,2013,33(21):5332-5334.
[6]金玉女.无创呼吸机治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床疗效[J].中国老年学杂志,2014,34(21):6020-6022.
[7]刘璇.慢性阻塞性肺疾病合并呼吸衰竭应用无创呼吸机治疗的疗效观察[J].中国急救医学,2015,35(z2):280-281.
[8]赵微微,于湘春,顾泽鑫.无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的疗效及对肺功能和血清炎症因子水平的影响[J].中国老年学杂志,2017,37(17):4329-4331.
[9]蔡明文.无创呼吸机联合纳洛酮治疗老年COPD并发呼吸衰竭的临床疗效分析[J].临床肺科杂志,2013,18(3):474-475.
[10]潘淼,刘白絮.纳洛酮联合无创正压通气治疗中老年慢性阻塞性肺疾病伴呼吸衰竭的疗效[J].中国老年学杂志,2014,34(20):5728-5729.
[11]丁晓英,李雯.舒利迭联合无创通气治疗老年慢性阻塞性肺疾病呼吸衰竭的疗效[J].中国老年学杂志,2015,35(10):2823-2825.
[12]刘振宽,张宇.无创机械通气联合雾化吸入药物治疗AECOPD并发呼吸衰竭的临床观察[J].中国药房,2016,27(20):2833-2835.
[13]刘长志.无创通气联合噻托溴铵在老年慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭的临床应用[J].中国老年学杂志,2014,34(2):514-515.
[14]黄怀焕,林俊锋.噻托溴铵加用布地奈德福莫特罗粉吸入剂联合无创通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的效果[J].中国医药导报,2015,12(5):91-94.
[15]韦荣新,李虹.无创通气联合布地奈德福莫特罗粉吸入剂治疗重度慢性阻塞性肺疾病合并慢性呼吸衰竭效果观察[J].中国临床医生杂志,2018,46(9):1028-1030.
[16]王爽,郑秀艳,孙文华,等.异丙托溴铵与布地奈德对COPD合并Ⅱ型呼吸衰竭患者MDA,SOD,GSH-Px水平及肺功能的影响[J].现代生物医学进展,2015,15(33):6512-6515.
[17]张钰.复方异丙托溴铵治疗急性加重期慢性阻塞性肺疾病患者79例[J].中国老年学杂志,2013,33(16):4046-4047.
[18]贾娟.异丙托溴铵联合舒利迭雾化吸入治疗慢性阻塞性肺病并发呼吸衰竭62例[J].陕西医学杂志,2013,42(5):628-629.
[19]郑玉兰,曾宪升.氨溴索联合异丙托溴铵治疗慢性阻塞性肺疾病急性加重期的疗效分析[J].中华老年医学杂志,2014,33(11):1210-1211.
[20]张春美,丁震,裴翀,等.无创机械通气联合经管道雾化吸入布地奈德治疗AECOPD合并Ⅱ型呼吸衰竭的疗效[J].实用医学杂志,2015,31(5):819-820.
[21]蒋明彦,刘国平,刘中华,等.两种不同吸入方法治疗慢性阻塞性肺疾病合并呼吸衰竭效果的研究[J].临床肺科杂志,2016,21(9):1624-1627.