无创正压通气治疗煤工尘肺合并呼吸衰竭的疗效研究

目的 探讨无创正压通气(NPPV)治疗煤工尘肺合并呼吸衰竭的疗效和安全性.方法 回顾分析2013年6月1日至2015年6月30日收治的煤工尘肺合并呼吸衰竭患者,共71例的临床资料.按是否进行无创正压通气分成NPPV组和对照组.主要观察指标是两组的病死率、气管插管率、呼吸机相关性肺炎(VAP)发生率、住院时间;次要观察指标是两组的基础、治疗后2~4h、治疗24~48h生命体征、动脉血气分析测值和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ).NPPV主要并发症包括气压伤、痰堵窒息、胃胀气、误吸、低血压.对数据应用SPSS软件进行统计学分析.结果 本研究共纳入对照组31例,NPPV组40例,.气管插管率NPPV组为12.5%(5/40),对照组为25.8%(8/31)(χ2=2.067,P=0.150);住院病死率,NPPV组为12.5%(5/40),对照组为29.0%(9/31)(χ2=3.015,P=0.082);VAP发生率,NPPV组为2.5%(1/40),对照组为9.6%(3/31)(P=0.311).NPPV组住院时间显著低于对照组(10.37±2.34)d vs(13.61±4.70)d,P=0.001].生理指标改变:治疗后2~4h,与对照组比较NPPV组呼吸(RR)、PaCO2得到更好的改善(P<0.05),NPPV组与基础比较收缩压(SBP)得到改善(P<0.05),心率(HR)、RR、PaCO2、PaO2有显著改善(P<0.01).治疗24~48h后,NPPV组与对照组两组间比较RR、PaCO2得到更好的改善(P<0.05),NPPV组与基础比较pH值得到改善(P<0.05),HR、SBP、RR、PaCO2和PaO2得到显著改善(P<0.01).结论 NPPV较常规治疗可以更好改善煤工尘肺合并呼吸衰竭患者的 HR、SBP、RR、pH、PaCO2和PaO2,缩短住院天数,是煤工尘肺合并呼吸衰竭患者的有效治疗手段,值得进一步多中心大样本前瞻性随机对照研究.

Efficacy of noninvasive positive pressure ventilation in the treatment of respiratory failure secondary to coal worker's pneumoconiosis

Objective To evaluate the efficacy and safety of non-invasive positive pressure ventilation(NPPV)on the coal-worker patients with pneumoconiosis complicated respiratory failure. Methods Data from 71 cases of coal worker patients with pneumoconiosis complicated respiratory failure hospitalized from 1st June 2013 to 30th June 2015 were retrospectively analyzed.The patients were categorized into NPPV group and control group by the fact whether they received NPPV treatment.For both groups,the major parameters observed in this study included mortality in hospital,trachea intubation rate,incidence of ventilator-associated pneumonia(VAP)and hospitalization duration;minor parameters included the vital signs at baseline,2-4 hours and 24-48 hours after treatment,arterial blood gas analysis and scores for Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ).The major NPPV-relevant complications included barotraumas,sputum asphyxia,gasteremphraxis,aspiration and hypotension.The collected data were statistically analyzed using SPSS software.Results The study included 40 cases in the NPPV group and 31 cases in the control group.The trachea intubation rate were 12.5%(5/40)in the NPPV group and 25.8%(8/31)in the control group(χ2=2.067,P=0.150).The hospital mortality was 12.5% in the NPPV group and 29.0%(9/31)in the control group(χ2=3.015,P=0.082).VAP incidence was 2.5%(1/40)in the NPPV group and 9.6%(3/31)in the control group(P =0.311).Patients in the NPPV group had shorter hospitalization durations than those in the control group (10.37±2.34 days vs 13.61±4.70 days,P=0.001).For the physiological parameters at 2-4 hours after treatment,the RR and PaCO2in the NPPV group were significantly lower than that in control group(P<0.05).In the NPPV group,HR,RR,PaCO2after treatment were lower that those at the baseline(P <0.01),PaO2after treatment were higher that those at the baseline(P<0.01).SBP in NPPV group was significantly lower than that of control group(P<0.01).For the physiological parameters at 24-48 hours after treatment,RR and PaCO2in the NPPV group were lowerthan that of control group(P <0.05). Post-treatment pH values,HR,SBP,RR and PaCO2in NPPV group were lower than that at the baseline( P<0.05 for pH values andP<0.01 for parameters),PaO2in NPPV group were higher than that at the baseline(P<0.01 for parameters).Conclusions Compared to the routine treatments,NPPV is favorable in improving the HR,SBP,RR,pH,PaCO2and PaO2parameters of coal worker pneumoconiosis complicated respiratory failure and shortens the hospitalization duration.Therefore,NPPV is effective to treat pneumoconiosis patients complicated respiratory failure,warranting a multiple-center,prospective randomized control study in a large sample size in the future.