Clinical observation of high-intensity non-invasive positive pressure ventilation in the treatment of AECOPD patients complicated with type Ⅱ respiratory failure
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摘要:
目的 探讨高强度与常规压力无创正压通气在治疗慢性阻塞性肺病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并Ⅱ型呼吸衰竭患者的疗效对比。 方法 收集2018年10月—2020年1月就诊于蚌埠市第三人民医院呼吸科AECOPD合并Ⅱ型呼吸衰竭的患者共72例, 应用简单随机法分为高强度组(36例)和常规压力组(36例),吸气压力分别设为(24.7±1.8)cm H2O(1 cm H2O=0.098 kPa)和(16.1±1.2)cm H2O,比较2组之间及组内治疗后2、6、24、48、72 h的pH、PaCO2、PaO2;使用无创通气的不良反应;气管插管率及病死率;住院天数;出院28 d后再入院率及6分钟步行距离。 结果 2组治疗前pH、PaO2、PaCO2差异无统计学意义(均P>0.05);治疗后pH、不良反应差异无统计学意义(均P>0.05);PaO2、PaCO2差异有统计学意义(均P<0.05);气管插管率分别为8.33%(3/36)和13.89%(5/36),病死率分别为2.78%(1/36)和8.33%(3/36),差异无统计学意义(均P>0.05);住院天数分别为(10.0±1.7)d和(13.2±1.9)d,差异有统计学意义(P<0.05);出院28 d后患者再入院率、6分钟步行距离差异无统计学意义(均P>0.05)。 结论 应用高强度无创正压通气可更快改善AECOPD合并Ⅱ型呼吸衰竭患者的PaO2、PaCO2,不良反应无明显增加,可缩短住院时间。 -
关键词:
- 慢性阻塞性肺病急性加重 /
- Ⅱ型呼吸衰竭 /
- 无创正压通气
Abstract:Objective To investigate the effect of high-intensity and conventional pressure non-invasive positive pressure ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with type Ⅱ respiratory failure. Methods A total of 72 patients with AECOPD and type Ⅱ respiratory failure in the Respiratory Department of Bengbu Third Hospital from October 2018 to January 2020 were included. They were divided into the high-intensity group (36 cases) and conventional pressure group (36 cases) by simple random method. The inspiratory pressure was set to (24.7±1.8) cm H2O and (16.1±1.2) cm H2O, respectively. The pH, PaCO2, PaO2 between the two groups and within 2, 6, 24, 48, 72 h after treatment, adverse effects of non-invasive ventilation, tracheal intubation rate and fatality rate, hospitalisation days, re-admission rate 28 days after discharge and 6-minute walking distance were compared. Results The differences in pH, PaO2 and PaCO2 between both groups before treatment were not statistically significant (all P>0.05). The differences in pH and adverse reactions after treatment were not statistically significant (all P>0.05). The differences in PaO2 and PaCO2 were statistically significant (all P>0.05). The tracheal intubation rate was 8.33% (3/36) and 13.89% (5/36). The fatality rate was 2.78% (1/36) and 8.33% (3/36); the difference were not statistically significant (all P>0.05). The number of hospitalisation days were (10.0±1.7) and (13.2±1.9) days. The difference was statistically significant (P < 0.05). No significant difference was observed in the readmission rate and 6-min walking distance of patients 28 days after discharge (both P>0.05). Conclusion The application of high-intensity non-invasive positive pressure ventilation can improve PaO2 and PaCO2 in patients with AECOPD combined with type Ⅱ respiratory failure more quickly, without a significant increase in adverse reactions. Moreover and shorten the hospital stay. -
表 1 2组AECOPD合并Ⅱ型呼吸衰竭患者血气分析值情况比较(x±s)
组别 例数 PaCO2(mm Hg) F值 P值 治疗前 治疗后2 h 治疗后6 h 治疗后24 h 治疗后48 h 治疗后72 h 高强度组 36 78.97±9.49 72.13±9.51a 66.08±9.46ab 60.67±9.54abc 55.83±8.35abcd 50.24±6.69abcde 688.526 < 0.001 常规压力组 36 78.07±9.05 77.10±8.83a 71.55±9.99ab 66.50±10.89abc 61.72±10.63abcd 56.47±8.60abcde 252.315 < 0.001 t值 0.370 2.059 2.140 2.172 2.354 3.094 P值 0.713 0.044 0.037 0.034 0.022 0.003 组别 例数 PaO2(mm Hg) F值 P值 治疗前 治疗后2 h 治疗后6 h 治疗后24 h 治疗后48 h 治疗后72 h 高强度组 36 54.32±2.91 63.91±3.46a 71.67±4.21ab 76.90±5.33abc 80.47±5.18abcd 83.02±3.43abcde 260.943 < 0.001 常规压力组 36 53.42±2.82 61.59±5.02a 68.94±4.64ab 73.29±3.94abc 77.29±4.32abcd 80.95±3.36abcde 266.934 < 0.001 t值 1.188 2.061 2.347 2.921 2.526 2.326 P值 0.240 0.044 0.022 0.005 0.014 0.024 组别 例数 pH F值 P值 治疗前 治疗后2 h 治疗后6 h 治疗后24 h 治疗后48 h 治疗后72 h 高强度组 36 7.30±0.03 7.32±0.02a 7.34±0.02ab 7.36±0.03abc 7.37±0.03abcd 7.40±0.04abcde 217.242 < 0.001 常规压力组 36 7.30±0.03 7.33±0.02a 7.33±0.02a 7.35±0.01abc 7.37±0.02abcd 7.39±0.02abcde 212.974 < 0.001 t值 0.049 1.211 1.359 1.669 0.906 1.136 P值 0.961 0.231 0.179 0.906 0.369 0.261 注:与治疗前比较, aP<0.01;与治疗后2 h比较,bP<0.01;与治疗后6 h比较,cP<0.01;与治疗后24 h比较,dP<0.01;与治疗后48 h比较,eP<0.01。 -
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