无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的研究

目的探讨无创气道正压通气(NIPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)呼吸衰竭的机理。方法100例AECOPD呼吸衰竭病人按数字表法随机分为对照组和试验组各50例,对照组采用常规医疗干预,试验组在对照组的基础上加用NIPPV治疗,并分别于治疗前和治疗后第7天进行膈肌肌电图检查,测定膈神经传导时间(PNCT)及动作电位幅度,并同时检测肺功能和血气分析,分别记录用力肺活量(FVC)、第1秒用力呼气容积占预计值百分比(FEV1占预计值%)、最大呼气流速(PEF)和pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)。结果试验组总有效率高于对照组(P<0.05);治疗前FVC、FEV1%、PEF、pH值、PaO2、PaCO2、PNCT及动作电位幅度的两组比较差异均无统计学意义(P>0.05);治疗后两组FEV1、PEF、PNCT显著升高(P<0.01),PaO2升高,PaCO2降低(P<0.05),而FVC、pH值、动作电位幅度的差异无统计学意义(P>0.05)。结论NIPPV治疗能改善AECOPD呼吸衰竭病人的膈神经传导速度,而常规医疗干预只能提高膈肌的动作电位幅度。

Study on non-invasive positive pressure ventilation the treatment of in respiratory failure in acute exacerbation of chronic obstructive pulmonary disease

Objective To investigate the therapeutic effect of non-invasive positive airway pressure ventilation (NIPPV) on respiratory failure in acute exacerbation of chronic obstructive pulmonary disease.Methods One hundred patients with respiratory failure in acute exacerbation of the chronic obstructive pulmonary disease were randomly divided into control group and treatment group. Both groups were given the routine therapy,and the treatment group was given NIPPV in addition.Diaphragm electromyogram was conducted in all cases to measure the phrenic nerve conduction time (PNCT) and the swing of action potential (AP) before treatment and 7 days after treatment. At the same time,lung function and blood gas analysis were measured.FVC,FEV1%,PEF,pH,PaO2 and PaCO2 were registered. Results The total efficiency of the two groups was significant difference(P<0.05).In FVC,FEV1,PEF,pH,PaO2,PaCO2,PNCT and AP between two groups,the difference was not significant before treatment(P>0.05)but significant after treatment(P<0.01).PaO2,PaCO2 showed significant difference(P<0.05),but no significant difference(P>0.05) in FVC,pH and AP.Conclusion For patients with acute exacerbation of chronic obstructive pulmonary disease,NIPPV treatment can improve conductive speed of phrenic nerve,while the routine treatment only increase the swing of action potential.