文章摘要

不同压力水平家庭无创通气对慢性阻塞性肺疾病合并II型呼吸衰竭的疗效

作者: 1魏凯凡, 1赵禹, 1李秀
1 安徽医科大学第三附属医院呼吸与危重症医学科,合肥 230001
通讯: 李秀 Email: 919296610@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.08.018

摘要

目的:研究不同压力水平家庭无创通气对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并II型呼吸衰竭的疗效。方法:选取2017年9月至2018年9月因COPD急性加重在安徽医科大学第三附属医院呼吸与危重症医学科住院,通过无创通气治疗后病情平稳仍伴有II型呼吸衰竭的45例患者,根据患者可耐受家庭无创呼吸机吸气压力(invasive ventilator inspiratory pressure,IPAP)水平,分为高压力无创通气组(高压力组;IPAP≥18 cmH2O;n=28)和低压力无创通气组(低压力组;IPAP<18 cmH2O;n=17)。比较治疗1年后两组患者的疗效。结果:无创呼吸机治疗前后比较:治疗后两组患者的总住院次数、总住院天数和改良英国医学研究学会呼吸困难指数(modified British medical research council,mMRC)评分均低于治疗前,差异有统计学意义(均P<0.05);高压力组治疗后PaCO2和COPD评估测试(COPD assessment test,CAT)较治疗前改善明显,差异有统计学意义(P<0.05),但低压组治疗后PaCO2和CAT评分较治疗前改善不明显(P>0.05)。无创呼吸机治疗后比较:高压力组较低压力组在改善PaCO2、CAT评分、mMRC评分,减少总住院次数和总住院天数方面均有统计学意义(P<0.05)。结论:高压力家庭无创通气对COPD合并II型呼吸衰竭的疗效优于低压力组,在临床上,若患者可耐受高压力水平无创通气,应推荐使用。
关键词: 家庭无创通气;压力水平;慢性阻塞性肺疾病;II型呼吸衰竭

Efficacy of high-intensity non-invasive ventilation in stable chronic obstructive pulmonary disease patients with type II respiratory failure

Authors: 1WEI Kaifan, 1ZHAO Yu, 1LI Xiu
1 Department of Respiratory and Intensive Care Unit, Third Affiliated Hospital of Anhui Medical University, Hefei 230001, China

CorrespondingAuthor: LI Xiu Email: 919296610@qq.com

DOI: 10.3978/j.issn.2095-6959.2020.08.018

Abstract

Objective: To study the efficacy of high-intensity non-invasive ventilation in stable chronic obstructive pulmonary disease patients with type II respiratory failure. Methods: Forty-five patients with chronic obstructive pulmonary exacerbation and type II respiratory failure in our department from September 2017 to September 2018 were selected, after treatment, the disease was still stable with carbon dioxide retention. According to the setting level of non-invasive ventilator inspiratory pressure (IPAP), it is divided into high-intensity non-invasive ventilation (IPAP ≥18 cmH2O) and low-intensity non-invasive ventilation group (IPAP <18 cmH2O). Among them, 28 people in high-intensity group and 17 people in the low-intensity group. Before and after treatment for 1 year, the efficacy in the two groups were compared. Results: After treatment, the two groups of hospitalizations, hospitalization days and modified British medical research council (mMRC) compared with before treatment, the differences were statistically significant (P<0.05), PaCO2 and COPD assessment test (CAT) scores in the high-intensity group were statistically significant (P<0.05), but not statistically significant in the low-intensity group (P>0.05). There were significant differences in the improvement of PaCO2, CAT scores, mMRC, reduction of hospitalizations and hospitalization days compared high-intensity group with low-intensity group (P<0.05). Conclusion: High-intensity non-invasive ventilation in patients with stable chronic obstructive pulmonary disease complicated with type II respiratory failure is better than low-intensity group. Clinically, if patients can tolerate high-pressure levels of non-invasive ventilation, it should be recommended.
Keywords: domiciliary non-invasive ventilation; pressure levels; chronic obstructive pulmonary disease; type II respiratory failure