双水平气道正压治疗慢性阻塞性肺疾病合并呼吸衰竭的临床疗效分析

目的观察双水平气道正压(BiPAP)无创机械通气(NIV)治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭的临床疗效。方法选择成都市第六人民医院呼吸内科2016年1月至2018年12月收治的120例COPD合并呼吸衰竭患者作为研究对象,将其随机分为2组,对照组(n=60)给予常规药物治疗+鼻导管低流量吸氧治疗,试验组(n=60)给予常规药物治疗+BiPAP联合NIV治疗;观察试验组和对照组患者治疗前和治疗后7 d的心率(HR)、呼吸频率(RR)、酸碱值(pH值)、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2),肺功能指标包括用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占预计值百分比(FEV1%pred)、急性生理功能与慢性健康评分表Ⅱ(APACHEⅡ)、血气改善时间和住院时间,统计试验组和对照组患者治疗前的并发症发生情况。结果试验组和对照组患者治疗前的HR、RR、pH值、PaCO2、PaO2、SaO2、FVC、FEV1、FEV1%pred、APACHEⅡ比较,差异无统计学意义(t=1.306、1.041、1.058、1.140、1.026、1.260、1.021、1.274、1.165、1.529,P值均>0.05),但治疗后组间HR、RR、pH值、PaCO2、PaO2、SaO2、FVC、FEV1、FEV1%pred、APACHEⅡ各项指标比较,差异有统计学意义(t=3.254、3.985、3.052、4.162、3.262、5.124、3.544、3.127、5.251、3.184,P值均<0.05);试验组和对照组患者的血气改善时间、住院时间、并发症发生率比较,差异有统计学意义(t=3.658、5.187,χ2=26.359,P值均<0.05)。结论BiPAP NIV可以有效治疗COPD合并呼吸衰竭,但需注意加强针对性护理干预,降低相关并发症发生风险。

Clinical analysis of double level positive airway pressure in the treatment of chronic obstructive pulmonary disease with respiratory failure

Objective To observe the clinical effect of bi-level positive airway pressure(BiPAP)non-invasive ventilation(NIV)in the treatment of chronic obstructive pulmonary disease(COPD)with respiratory failure.Methods A total of 120 patients with COPD and respiratory failure who were treated in the Department of Respiratory Medicine of the Sixth People′s Hospital of Chengdu from January 2016 to December 2018 were selected as the research subjects.They were randomly divided into 2 groups,and the control group(n=60)was given conventional medication Nasal catheter low-flow oxygen inhalation therapy,the experimental group(n=60)was given conventional medication+BiPAP combined with NIV treatment;the heart rate(HR),respiration rate(RR),pH value,partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen in artery(PaO2),arterial oxygen saturation(SaO2),forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1%pred,Acute Physiology and Chronic Health Evaluation scoring system(APACHEⅡ),blood gas improvement time hospital stay,complications before the statistical test group and control group patients were observed.Results The experimental group and the control group patients before treatment of HR,RR,pH and PaCO2,PaO2,SaO2,FVC,FEV1,FEV1%pred,APACHEⅡthere were no statistically significant difference comparing(t=1.306,1.041,1.058,1.140,1.026,1.260,1.021,1.274,1.165,1.529,all P>0.05),but after treatment group comparison between HR,RR,pH,PaCO2,PaO2,SaO2,FVC,FEV1,FEV1%pred,APACHEⅡeach index difference were statistically significant(t=3.254,3.985,3.052,4.162,3.262,5.124,3.544,3.127,5.251,3.184,all P<0.05).There were significant differences in blood gas improvement time,hospitalization time and complication rate between the experimental group and the control group(t=3.658,5.187,χ2=26.359,both P<0.05).Conclusions BiPAP NIV can effectively treat COPD complicated with respiratory failure,but attention should be paid to strengthen targeted nursing intervention to reduce the risk of related complications.