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河北医学  2021, Vol. 27 Issue (7): 1200-1204    DOI: 10.3969/j.issn.1006-6233.2021.07.031
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有创-无创序贯机械通气对COPD伴Ⅱ型呼吸衰竭和肺心病患者治疗效果的观察
高婧, 滕海风
山东省威海市立医院重症医学科, 山东 威海 264200
Effect of Sequential Invasive-Non-Invasive Sequential Mechanical Ventilation on COPD Patients with Type II Respiratory Failure and Pulmonary Heart Disease
GAO Jing, TENG Haifeng
Weihai Municipal Hospital, Shandong Weihai 264200, China
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摘要 目的: 探讨有创-无创序贯机械通气对慢性阻塞性肺疾病(COPD)伴Ⅱ型呼吸衰竭和肺心病患者血气、肺功能和呼吸机相关性肺炎(VAP)发生的影响。方法: 选取我院于2017年12月至2018年12月期间收治的70例COPD合并肺心病伴Ⅱ型呼吸衰竭患者,随机分为试验组和对照组各35例。两组均先予气管插管机械通气,在达到无创通气指征后,试验组改为无创面罩机械通气,对照组继续予单纯有创机械通气。将两组治疗前后SBP、PaO2、PaCO2、PH值和HR,肺功能指标,病死率,VAP发生率,机械通气总时间及住院时间等指标进行对比分析。结果: 治疗前两组收缩压(SBP)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血酸碱度(PH值)和心率(HR)比较,差异均无统计学意义(P>0.05);两组治疗后SBP、PaO2、PH值均显著高于治疗前(t=-1.39,-2.99,-9.75,-12.60,-8.36,-8.36,均P<0.05),HR和PaCO2均低于治疗前(t=5.44,8.26,7.19,10.80,P<0.05)。两组治疗前肺功能指标比较差异均无统计学意义(P>0.05);治疗后两组肺功能指标均显著高于治疗前(t=-2.69,-3.67,-5.45,-5.38,P<0.05)。试验组VAP发生率为2.80%,显著低于对照组的20.00%(χ2=5.814,P<0.05);试验组机械通气时间显著低于对照组(t=5.196,P<0.05);试验组住院时间显著低于对照组;两组病死率比较并无显著性差异(P>0.05)。结论: 有创-无创序贯机械通气对COPD合并肺心病伴Ⅱ型呼吸衰竭患者的血气、肺功能指标改善效果更显著,呼吸机相关肺炎发生率更低,值得在临床上加以推广运用。
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高婧
滕海风
关键词 机械通气慢性阻塞性肺疾病肺心病Ⅱ型呼吸衰竭呼吸机相关肺炎    
AbstractObjective: To discuss the effects of two different mechanical ventilation (invasive-non-invasive sequential mechanical ventilation and simple invasive mechanical ventilation) on blood gas, pulmonary function and ventilator associated pneumonia (VAP) in patients with chronic obstructive pulmonary disease (COPD) complicated with type II respiratory failure and pulmonary heart disease. Methods: From December 2017 to December 2018, 70 patients with COPD with pulmonary heart disease complicated with type Ⅱ respiratory failure were randomly divided into two groups: test group (n = 35) and control group (n=35). In the control group, 35 patients were given mechanical ventilation by endotracheal intubation first. After reaching the indication of non-invasive ventilation, the test group was changed to non-invasive mask mechanical ventilation, and the control group continued to be treated with simple invasive mechanical ventilation. Systolic blood pressure (SBP), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), pH, heart rate (HR), pulmonary function, mortality and VAP were measured before and after treatment in two groups. The incidence, the total duration of mechanical ventilation and the length of hospitalization were compared and analyzed. Results: There was no significant difference in SBP,PaO2,PaCO2, PH and HR between the two groups before and after treatment (P>0.05). The levels of SBP,PaO2, PH after treatment in both groups were significantly higher than those before treatment(t=-1.39,-2.99,-9.75,-12.60,-8.36,-8.36, all P<0.05), and the levels of HR and PaCO2 were lower than those before treatment (t=5.44,8.26,7.19,10.80, all P<0.05). There was no significant difference in pulmonary function between the two groups before treatment (P>0.05), but the pulmonary function indexes in two groups after treatment were significantly higher than those before the treatment (t=-2.69,-3.67, -5.45,-5.38, all P<0.05). The incidence of VAP in test group was 2.80. %, significantly lower than 20.00% in control group (χ2= 5.814, P<0.05), and the duration of mechanical ventilation in the test group was significantly shortened compared with control group (t = 5.196, P<0.05). The hospitalization time in test group was significantly lower than that in control group, and there was no significant difference in the mortality between the two groups (P>0.05). Conclusion: Invasive-non-invasive sequential mechanical ventilation can improve pulmonary function and reduce the incidence of ventilator-associated pneumonia in patients with COPD complicated with cor pulmonale with type Ⅱ respiratory failure. It is worthy of promotion and application in clinic.
Key wordsMechanical ventilation    Chronic obstructive pulmonary disease    Pulmonary heart disease    Type II respiratory failure    Ventilator associated pneumonia
    
基金资助:山东省科技计划项目,(编号:201906310221)
引用本文:   
高婧, 滕海风. 有创-无创序贯机械通气对COPD伴Ⅱ型呼吸衰竭和肺心病患者治疗效果的观察[J]. 河北医学, 2021, 27(7): 1200-1204.
GAO Jing, TENG Haifeng. Effect of Sequential Invasive-Non-Invasive Sequential Mechanical Ventilation on COPD Patients with Type II Respiratory Failure and Pulmonary Heart Disease. HeBei Med, 2021, 27(7): 1200-1204.
链接本文:  
http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.07.031     或     http://www.hbyxzzs.cn/CN/Y2021/V27/I7/1200
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