不同时机行有创机械通气治疗慢阻肺急性发作合并重度呼吸衰竭患者的对照研究被引量：71

A CONTRAST STUDY ON INVASIVE MECHANICAL VENTILATION IN TREATING COPD WITH SERIOUS RESPIRATORY FAILURE AT DIFFERENT STARTING TIME

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摘要目的研究不同时机行有创机械通气治疗慢阻肺急性发作合并重度呼吸衰竭患者的治疗效果。方法选择2012年3月—2015年9月该院干部病房、ICU、呼吸内科诊治的急性加重期慢阻肺合并呼吸衰竭的患者80例,按使用有创呼吸机械的时间分组,6h前为观察组和6h后为对照组,均为40例,对二组实行有创机械通气治疗前后的临床指标、血气分析指标数据、肺功能指标和生活质量评分进行比较。结果观察组的有创通气时间、总机械通气时间和ICU住院时间均比对照组的值要低,二组间比较差异具有统计学意义(P<0.01);观察组和对照组在血流变学、呼吸频率、PaCO2、PaCO2/FiO2和血氧分压在治疗前的血气分析数据比较,差异无统计学意义(P>0.05),治疗后观察组的疗效明显比治疗前要好,且比对照组治疗后的疗效要明显,二组间治疗后差异具有统计学意义(P<0.01);观察组和对照组治疗前FEV1%、FEV1/FVC和呼吸困难指数二组比较差异无统计学意义(P>0.05),治疗后观察组和对照组均比治疗前效果好,观察组治疗后比对照组效果显著,差异具有统计学意义(P<0.01);观察组和对照组在生活质量表PF、RP、BP、GH、VT、SF、RE和MH各值治疗前比较,差异无统计学意义(P>0.05),治疗后均比治疗前效果好,观察组治疗后显著比对照组效果明显好,差异具有统计学意义(P<0.01)。结论慢阻肺急性发作合并重度呼吸衰竭患者应尽早进行有创机械通气治疗,有创机械通气治疗能缩短患者的住院时间,降低患者经济开支,提升了患者住院治疗的好转率,有效的改善相关症状,降低了撤机困难的出现率。 Objective To investigate the treatment effect of invasive mechanical ventilation in treating COPD with serious respiratory failure at different starting time.Methods Eighty cases of COPD with serious respiratory failure in cadre＇s ward,ICU,respiration medicine in author＇s hospital from March 2012 to September 2015 were selected and divided into observation group（before 6h）and control group（after 6h）,40 cases in each group.The clinic index,blood gas analysis index data,lung function indices and life quality score of the two groups were compared.Results Invasive ventilation time,total mechanical ventilation time and ICU hospital stay of observation group were lower than control group,the difference was statisticsignificant（P〈0.01）;before treatment,the difference of the two groups on hemorrheology,respiratory rate,PaCO2,PaCO2/FiO2 and PjvO was not statistic significant（P〉0.05）;after treatment,clinic effect of observation group was better than control group,the difference was statistic significant（P〈0.01）.Before treatment,FEV1%,FEV1/FVC and dyspnea of observation group and control group had no statistic significant（P〉0.05）,after treatment,clinic effect of the two groups were all improved than before,observation group was better than control group,the difference was statistic significant（P〈0.01）;Compared the life quality table PF,RP,BP,GH,VT,SF,RE and MH of the two groups,the difference was not statistic significant（P〉0.05）,clinic effect was better than before treatment,observation group was better than control group,the difference was statistic significant（P〈0.01）.Conclusion Patients with COPD and serious respiratory failure should be given invasive mechanical ventilation.It can shorten hospital stay,lower economic costs,increase improvement rate,improve associated symptom and lower the difficulty in withdrawing the mechanical ventilation.