无创通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭临床分析

doi:10.3877/cma.j.issn.1674-6902.2021.03.002

目的

评价双水平气道正压(BiPAP)无创机械通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者的临床疗效及其安全性。

方法

回顾我院呼吸内科2015年1月至2018年6月住院治疗的378例AECOPD合并Ⅱ型呼吸衰竭患者的临床资料，根据治疗方式分为观察组198例和对照组180例。对照组采用常规治疗，观察组在对照组治疗基础上接受经口鼻面罩BiPAP无创机械通气。记录治疗前、治疗2 h、治疗后24 h的血气分析指标、临床缓解情况以及不良反应发生情况，并比较组间差异。

结果

治疗2 h后，观察组患者pH、氧合指数(PaO₂/FiO₂)、动脉血氧分压(PaO₂)、乳酸水平改善显著(P<0.05)，对照组无显著改善(P>0.05)。治疗24 h后，两组患者pH、PaO₂/FiO₂、PaO₂、乳酸水平均显著改善，且观察组患者比对照组患者改善更显著(P<0.05)。两组患者治疗后3 d临床缓解率无显著差异(χ²＝1.042，P＝0.307)，治疗后5 d、7 d观察组患者临床缓解率均明显高于对照组(P<0.05)。两组患者胃胀气、口咽溃疡、口腔真菌发生率均无显著差异(P>0.05)，观察组肺性脑病发生率(3.03% vs. 10.0%，P＝0.006)及气管插管率(7.57% vs. 11.11%，P＝0.033)均明显低于对照组；无创通气合理使用可有效降低患者的平均住院日和医疗费用。

结论

经口鼻面罩BiPAP无创机械通气是治疗AECOPD合并Ⅱ型呼吸衰竭的一种有效安全的治疗手段。

关键词: 肺疾病, 慢性阻塞性, Ⅱ型呼吸衰竭, 无创机械通气

Objective

To evaluate the clinical efficacy and safety of bi-level positive airway pressure (BiPAP) noninvasive mechanical ventilation in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with type Ⅱ respiratory failure.

Methods

The clinical data of 378 patients with AECOPD combined with type Ⅱ respiratory failure who were hospitalized from January 2015 to June 2018 in our Department of Respiratory Medicine were reviewed. They were divided into observation group 198 cases and control group 180 cases according to treatment methods. The control group received conventional treatment, and the observation group received non-invasive mechanical ventilation with oral nasal mask BiPAP based on the treatment of the control group. Blood gas analysis indicators, clinical remissions, and adverse reactions were recorded before treatment, 2 hours, and 24 hours after treatment, and the differences between groups were compared.

Results

After 2 hours of treatment, the patients in the observation group had significant improvements in pH, oxygenation index (PaO₂/FiO₂), PaO₂, and lactic acid levels (P<0.05), while the control group had no significant improvement (P>0.05). After 24 hours of treatment, the pH, PaO₂/FiO₂, PaO₂, and lactic acid levels of the two groups of patients improved significantly, and the patients in the observation group improved more significantly than those in the control group (P<0.05). There was no significant difference in the clinical response rate between the two groups after 3 days of treatment (χ²=1.042, P=0.307). The clinical response rate of the observation group was significantly higher than that of the control group at 5 and 7 days after treatment (P<0.05). There was no significant difference in the incidence of flatulence, oropharyngeal ulcers, and oral fungi in the two groups (P>0.05). The incidence of pulmonary encephalopathy (3.03% vs. 10.0%, P=0.006) and tracheal intubation rate (7.57% vs. 11.11%, P=0.033) in the observation group were significantly lower than those in the control group; the reasonable use of noninvasive ventilator can effectively reduce the average hospitalization day and medical expenses of patients.

Conclusion

Oral and nasal mask BiPAP noninvasive mechanical ventilation is an effective treatment for AECOPD combined with type Ⅱ respiratory failure, and it is worthy of clinical application.

Key words: Chronic obstructive pulmonary disease, Type Ⅱ respiratory failure, Noninvasive mechanical ventilation

表1 两组患者治疗前后血气分析指标变化(±s)

组　别	例数	时间	pH	PaO₂/FiO₂	PaCO₂(mmHg)	乳酸(mmol/L)
观察组	198	治疗前	7.28±0.25	160.34±17.59	70.84±8.40	6.42±1.20
		治疗后2 h	7.33±0.10^ab	185.85±20.93^ab	60.21±6.92^ab	5.20±0.83^ab
		治疗后24 h	7.40±0.08^ab	257.69±25.02^ab	52.75±4.70^ab	3.89±0.44^ab
对照组	180	治疗前	7.29±0.25	160.27±17.88	70.80±8.49	6.39±1.25
		治疗后2 h	7.30±0.25	161.05±17.42	70.12±8.62	6.30±1.29
		治疗后24 h	7.37±0.15^a	209.83±20.62^a	61.21±5.60^a	4.72±0.62^a

表1 两组患者治疗前后血气分析指标变化(±s)

组　别	例数	时间	pH	PaO₂/FiO₂	PaCO₂(mmHg)	乳酸(mmol/L)
观察组	198	治疗前	7.28±0.25	160.34±17.59	70.84±8.40	6.42±1.20
		治疗后2 h	7.33±0.10^ab	185.85±20.93^ab	60.21±6.92^ab	5.20±0.83^ab
		治疗后24 h	7.40±0.08^ab	257.69±25.02^ab	52.75±4.70^ab	3.89±0.44^ab
对照组	180	治疗前	7.29±0.25	160.27±17.88	70.80±8.49	6.39±1.25
		治疗后2 h	7.30±0.25	161.05±17.42	70.12±8.62	6.30±1.29
		治疗后24 h	7.37±0.15^a	209.83±20.62^a	61.21±5.60^a	4.72±0.62^a

表2 两组患者临床缓解率的比较[n(%)]

组　别	例数	治疗后3 d	治疗后5 d	治疗后7 d
观察组	198	19(9.60)	91(45.96)	150(75.76)
对照组	180	13(7.22)	63(35.00)	112(65.00)
χ²值		1.042	4.690	13.835
P值		0.307	0.030	<0.001

表2 两组患者临床缓解率的比较[n(%)]

组　别	例数	治疗后3 d	治疗后5 d	治疗后7 d
观察组	198	19(9.60)	91(45.96)	150(75.76)
对照组	180	13(7.22)	63(35.00)	112(65.00)
χ²值		1.042	4.690	13.835
P值		0.307	0.030	<0.001

表3 两组气管插管率、平均住院日和医疗总费用比较

组　别	例数	气管插管率[n(%)]	平均住院日(d)	总医疗费用(元)
观察组	198	15(7.57)	8.52±3.75	9 155±2 158
对照组	180	20(11.11)	11.70±4.24	1 1967±3 758
χ²值		10.487	/	/
P值		0.033	0.026	0.022

表3 两组气管插管率、平均住院日和医疗总费用比较

组　别	例数	气管插管率[n(%)]	平均住院日(d)	总医疗费用(元)
观察组	198	15(7.57)	8.52±3.75	9 155±2 158
对照组	180	20(11.11)	11.70±4.24	1 1967±3 758
χ²值		10.487	/	/
P值		0.033	0.026	0.022

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Clinical effect of noninvasive ventilator in the treatment of chronic obstructive pulmonary disease with acute exacerbation and type Ⅱ respiratory failure

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Clinical effect of noninvasive ventilator in the treatment of chronic obstructive pulmonary disease with acute exacerbation and type Ⅱ respiratory failure