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无创正压机械通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床效果观察

The clinical effect observation of the non invasive positive pressure mechanical ventilation for the treatment of chronic obstructive pulmonary disease with Ⅱrespiratory failure

摘要:

目的:探讨创无创正压机械通气对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者的肺功能及血气分析的影响。方法选择 COPD 合并Ⅱ型呼吸衰竭患者120例,采用随机数字表法将患者分为对照组和观察组,各60例。对照组给予常规低流量给氧治疗;观察组应用无创正压通气治疗。观察治疗前及治疗1周后血气水平变化、一秒用力呼气量(FEV1)、一秒钟用力呼气容积占用力肺活量比值(FEV1/FVC)及插管率、平均住院时间等指标。结果观察治疗后两组 FEV1、FEV1/FVC(%)、PaO2、pH 均高于治疗前,PaCO2低于治疗前,差异均有统计学意义(t =8.33、12.56、14.71、10.82、7.88、10.14、13.20、15.63、11.48、8.37,均 P <0.05)。观察组治疗后 FEV1和 FEV1/FVC(%)分别为(2.84±0.42)L 和(69.93±0.72)%,高于对照组的(2.69±0.39)L 和(67.11±0.78)%,差异有统计学意义(t =8.95、10.76,均 P <0.05);观察组治疗后 PaO2和 pH 分别为(77.90±1.12)mmHg 和(7.41±0.10),均高于对照组治疗后(70.88±1.14)mmHg 和(7.29±0.08),差异有统计学意义(t =11.58、7.94,均 P <0.05)。观察组治疗后 PaCO2为(50.14±1.23)mmHg,低于治疗前的(54.26±1.12)mmHg,差异有统计学意义(t =9.81,P <0.05);观察组插管率为1.67%(1/60),低于对照组的13.33%(8/60),差异有统计学意义(χ2=7.90,P <0.05)。观察组平均住院时间为(11.69±1.32)d,低于对照组的(15.10±1.28)d,差异有统计学意义(t =9.84,P <0.05)。结论无创正压机械通气能显著改善 COPD 合并Ⅱ型呼吸衰竭患者的肺功能,提高 PaO2,改善患者呼吸状况,降低插管率,缩短住院时间。

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abstracts:

Objective To explore the noninvasive positive pressure ventilation combined with pulmonary function and blood gas analysis of chronic obstructive pulmonary disease(COPD)with type Ⅱ respiratory failure. Methods 120 COPD patients with type II respiratory failure were selected,they were randomly divided into the con-trol group and observation group by using the random number table method,with 60 cases each group.The control group was given conventional low flow oxygen therapy,the observation group was application of noninvasive positive pressure ventilation treatment.The change of blood gas levels,the forced expiratory volume in one second (FEV1 ), forced expiratory volume in one second to forced vital capacity ratio (FEV1 /FVC)before treatment and after one week treatment,and the intubation rate,the average hospitalization time were observed.Results After treatment,FEV1 , FEV1 /FVC (%),PaO2 ,pH of the two groups were higher than those before treatment,while PaCO2 was lower than that before treatment,the differences were statistically significant (t =8.33,12.56,14.71,10.82,7.88,10.14, 13.20,15.63,11.48,8.37,all P <0.05).FEV1 and FEV1 /FVC (%)of the observation group after treatment were (2.84 ±0.42)L and (69.93 ±0.72),which were higher than those of the control group after the treatment (2.69 ± 0.39)L and (67.11 ±0.78),the difference was statistically significant (t =8.95,10.76,all P <0.05).PaO2 and pH of the observation group after treatment were (77.90 ±1.12)mmHg and (7.41 ±0.10),which were higher than those of the control group after treatment (70.88 ±1.14)mmHg and (7.29 ±0.08),the difference was statistically significant (t =11.58,7.94,all P <0.05).PaCO2 of the observation group was (50.14 ±1.23)mmHg,which was lower than that of before treatment (54.26 ±1.12)mmHg,the difference was statistically significant (t =9.81,P <0.05).The intubation rate of the observation group was 1.67% (1 /60),which was lower than that of the control group 13.33% (8 /60),the difference was statistically significant (χ2 =7.90,P <0.05).The average hospital stay time of the observation group was (11.69 ±1.32)d,which was lower than that of the control group(15.10 ±1.28)d, the difference was statistically significant (t =9.84,P <0.05).Conclusion Noninvasive positive pressure ventila-tion could significantly improve lung function of COPD patients with type II respiratory failure,increase PaO2 ,improve the respiratory status of the patients,reduce intubation rate and shorten the hospitalization time.

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作者: 权利珍 [1]
作者单位: 湖州市吴兴区人民医院内科, 浙江省湖州,313008 [1]
期刊: 《中国基层医药》2015年15期 2347-2349页 ISTIC
栏目名称: 论 著
DOI: 10.3760/cma.j.issn.1008-6706.2015.15.034
发布时间: 2015-08-26
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