无创正压通气治疗不同表型慢性阻塞性肺疾病急性加重期合并呼吸衰竭的临床疗效被引量：7

Clinical efficacy of non-invasive positive pressure ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease with respiratory failure of different phenotypes

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摘要目的探讨无创正压通气(NPPV)治疗不同表型慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者的临床疗效。方法选择我院2018年5月至2020年5月收治的AECOPD合并呼吸衰竭患者143例,根据过去1年急性加重次数分为非频繁急性加重(<2次/年)组71例和频繁急性加重(≥2次/年)组72例。按照随机分组法,非频繁急性加重组分为对照组非频繁型(常规治疗)36例和观察组非频繁型(常规治疗+NPPV)35例;频繁急性加重组分为对照组频繁型(常规治疗)36例和观察组频繁型(常规治疗+NPPV)36例。观察血气指标变化和NPPV治疗效果及合并症的构成情况。结果观察组非频繁型治疗24 h、3 d和7 d时血气指标与对照组非频繁型比较,差异无统计学意义(P>0.05);观察组频繁型经NPPV治疗24 h、3 d和7 d时pH值、PaCO_(2)和PaO_(2)与对照组频繁型比较,差异有统计学意义(P<0.05)。对于采用NPPV治疗的AECOPD合并呼吸衰竭患者,频繁急性加重组患者的24 h、3 d和7 d时pH值、PaCO_(2)和PaO_(2)与非频繁急性加重组比较,差异有统计学意义(P<0.05)。频繁急性加重组合并睡眠呼吸暂停低通气综合征(SAHS)较非频繁急性加重组明显增多(26.39%vs.11.27%),差异有统计学意义(P<0.05)。结论对于频繁急性加重表型的AECOPD并呼吸衰竭患者,尤其是合并SAHS患者,建议尽早行无创正压通气治疗,以期获得更好的临床效果。 Objective To investigate the clinical efficacy of non-invasive positive pressure ventilation(NPPV)in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with respiratory failure of different phenotypes.Methods A total of 143 patients with AECOPD complicated with respiratory failure admitted to our hospital from May 2018 to May 2020 were selected and divided into infrequent acute exacerbation group(<2 times/year,n=71)and frequent acute exacerbation group(≥2 times/year,n=72)according to the number of exacerbations in the past year.According to the randomization method,the infrequent acute exacerbation group consisted of 36 cases of infrequent exacerbation in the control group(conventional treatment)and 35 cases of infrequent exacerbation in the observation group(conventional treatment+NPPV).The frequent exacerbation group consisted of 36 cases of frequent exacerbation(conventional treatment)in the control group and 36 cases of frequent exacerbation(conventional treatment+NPPV)in the observation group.The changes in blood gas parameters and the therapeutic effect of NPPV,and the composition of complications were observed.Results There was no significant difference in blood gas indexes of the infrequent exacerbation between the observation and control groups at 24 h,3 d,and 7 d after treatment(P>0.05).There were significant differences in pH value,PaCO_(2),and PaO_(2) of the frequent exacerbation between the observation and control groups at 24 h,3 d,and 7 d after NPPV treatment(P<0.05).For AECOPD patients with respiratory failure treated with NPPV,there were significant differences in pH,PaCO_(2) and PaO_(2) at 24 hours,3 days and 7 days between frequent acute exacerbation group and non-frequent acute exacerbation group(P<0.05).The combination of sleep apnea-hypopnea syndrome(SAHS)in the frequent acute exacerbation group was significantly increased compared with that in the infrequent acute exacerbation group(26.39%vs.11.27%),and the difference had statistical significance(P<0.05).C

作者黄颂平陈冬冬蔡志明沈冰寒叶晓艺 HUANG Songping;CHEN Dongdong;CAI Zhiming;SHEN Binghan;YE Xiaoyi(Department of Respiratory and Critical Care Medicine,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou 362000,China)

机构地区福建医科大学附属泉州第一医院呼吸与危重症医学科

出处《中国现代医生》 2021年第29期28-31,35,共5页 China Modern Doctor

基金福建省泉州市科技计划项目(2O17Z037)。

关键词慢性阻塞性肺疾病表型无创正压通气呼吸衰竭 Chronic obstructive pulmonary disease Phenotype Non-invasive positive pressure ventilation Respiratory failure

分类号 R563.9 [医药卫生—呼吸系统] R563.8 [医药卫生—内科学]