无创正压通气在慢性阻塞性肺疾病急性加重期合并急性左心功能不全的疗效分析
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摘要
目的评估无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并急性左心功能不全的临床疗效。方法选择我院于2016年1月～2018年12月收治慢性阻塞性肺疾病急性加重期合并急性左心功能不全患者65例,按照治疗方法不同,分为对照组及治疗组,其中对照组30例,治疗组35例。常规治疗组为对照组,在常规治疗基础上采用无创正压通气治疗组为治疗组。评估两组治疗前后血气分析结果、住院天数、B型钠尿肽(BNP)等指标。结果治疗组的PH、PCO_2、PO_2、BNP在治疗前后比较,差异有统计学意义(P <0.05);对照组的PH、PCO_2、PO_2在治疗前后比较,差异无统计学意义(P> 0.05),对照组的BNP在治疗前后比较,差异有统计学意义(P <0.05);对比两组治疗后PH、PO_2、PCO_2、BNP以及两组住院天数比较,差异有统计学意义(P <0.05)。结论在常规治疗基础上,采用无创正压通气治疗慢性阻塞性肺疾病急性加重期合并急性左心功能不全患者可明显缩短患者住院时间,临床疗效显著,值得基层医院推广。
Objective To assess the clinical efficacy of non-invasive positive pressure ventilation(NPPV) in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and acute left ventricular dysfunction. Methods Enrolled Sixty-five patients with acute exacerbation of chronic obstructive pulmonary disease and acute left ventricular dysfunction who were admitted to our hospital from January 2016 to December 2018.According to different treatment methods,they were divided into control group and treatment group,including 30 patients in the control group and 35 patients in the treatment group.The routine treatment group was the control group, and the non-invasive positive pressure ventilation treatment group was used as the treatment group based on routine treatment.Blood gas analysis,hospitalization days,B-type natriuretic peptide(BNP) were analyzed before and after treatment in both groups. Results In the treatment group,the difference of PH,PCO_2,PO_2 and BNP between after treatment and before treatment was statistically significant(P < 0.05).In the control group,there was no significant difference of PH,PCO_2 and PO_2 between after treatment and before treatment(P > 0.05),while the difference of BNP was statistically significant between after treatment and before treatment(P < 0.05).In addition,there was no significant difference in the improvement rate of PH between the two groups(P > 0.05),but the difference of PO_2 improvement rate, PCO_2 decline rate,BNP decrease rate and hospitalization days between the two groups were statistically significant(P < 0.05). Conclusion Based on routine treatment,non-invasive positive pressure ventilation in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease and acute left ventricular dysfunction could significantly shorten hospitalization days,which indicated great clinical efficacy and is worthy of promotion in primary hospitals.
Objective To assess the clinical efficacy of non-invasive positive pressure ventilation(NPPV) in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and acute left ventricular dysfunction. Methods Enrolled Sixty-five patients with acute exacerbation of chronic obstructive pulmonary disease and acute left ventricular dysfunction who were admitted to our hospital from January 2016 to December 2018.According to different treatment methods,they were divided into control group and treatment group,including 30 patients in the control group and 35 patients in the treatment group.The routine treatment group was the control group, and the non-invasive positive pressure ventilation treatment group was used as the treatment group based on routine treatment.Blood gas analysis,hospitalization days,B-type natriuretic peptide(BNP) were analyzed before and after treatment in both groups. Results In the treatment group,the difference of PH,PCO_2,PO_2 and BNP between after treatment and before treatment was statistically significant(P < 0.05).In the control group,there was no significant difference of PH,PCO_2 and PO_2 between after treatment and before treatment(P > 0.05),while the difference of BNP was statistically significant between after treatment and before treatment(P < 0.05).In addition,there was no significant difference in the improvement rate of PH between the two groups(P > 0.05),but the difference of PO_2 improvement rate, PCO_2 decline rate,BNP decrease rate and hospitalization days between the two groups were statistically significant(P < 0.05). Conclusion Based on routine treatment,non-invasive positive pressure ventilation in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease and acute left ventricular dysfunction could significantly shorten hospitalization days,which indicated great clinical efficacy and is worthy of promotion in primary hospitals.
引文
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[4]中华医学会呼吸病学分会.无创正压通气临床应用专家共识[J].中华结核和呼吸杂志,2009,32(2):86-98.
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[6]慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治专家共识(2017年更新版)[J].国际呼吸杂志,2017,37(14):1041-1057.
[7]王保国,周建新.实用呼吸机治疗学[M].第2版,北京:人民卫生出版社,2005:52-55.
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[9]Chandra D,Stamm JA,Taylor B,et a1.Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulm-onary disease in the United States,1998-2008[J].Am J Respir Grit Gare Med,2012,185(2):152-159.
[10]Salman A,Milbrandt EB,Pinsky MR,et a1.The role ofnoninvasive ventilation in acute cardiogenic pulmonary edema[J].Grit Care,2010,14(2):303-308.
[11]姚睿.拒绝气管插管的AECOPD并严重呼吸性酸中毒及意识障碍患者行无创正压通气治疗的疗效分析[J].临床医学研究与实践,2017,2(34):59-60.
[12]全新玉.拒绝气管插管的慢性阻塞性肺疾病急性加重并严重呼吸性酸中毒及意识障碍患者行无创正压通气治疗的疗效分析[J].中国实用医学,2017,12(25):67-68.
[13]吴春风,崔佰君.拒绝气管插管的慢性阻塞性肺疾病急性加重并严重呼吸性酸中毒及意识障碍患者行无创正压通气治疗的疗效分析[J].中国老年学杂志,2015,35(23):6810-6811.
[14]中国医师协会急诊医师分会,中国医疗保健国际交流促进会急诊急救分会,国家卫生健康委能力建设与继续教育中心急诊学专家委员会.无创正压通气急诊临床实践专家共识(2018)[J].中华急诊医学杂志,2019,28(1):14-24.
[15]李报春,刘大锐,王海艳,等.无创正压通气治疗慢性阻塞性肺疾病急性加重合并重度呼吸性酸中毒[J].实用医药杂志,2014,31(12):1082-1083.
[16]梁世康,高兴华,赵献连.无创正压通气治疗COPD伴Ⅱ型呼吸衰竭疗效观察[J].临床肺科杂志,2008,13(6):701-702.
[2]Yin P,Wang H,Vos T,et al.A subnational analysis of mortality and prevalence of COPD in China from 1990 to2013:findings from the global burden of disease study2013[J].Chest,2016,150(6):1269-1280.
[3]中华医学会呼吸病学分会慢性阻塞性肺疾病组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[4]中华医学会呼吸病学分会.无创正压通气临床应用专家共识[J].中华结核和呼吸杂志,2009,32(2):86-98.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性心力衰竭诊断和治疗指南[J].中华心血管病杂志,2010,38(3):195-208.
[6]慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治专家共识(2017年更新版)[J].国际呼吸杂志,2017,37(14):1041-1057.
[7]王保国,周建新.实用呼吸机治疗学[M].第2版,北京:人民卫生出版社,2005:52-55.
[8]Burns KEA,Meade MO,Premji A,et al.Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure:a cochrane systematic review[J].CMAJ,2014,186(3):E112-122.
[9]Chandra D,Stamm JA,Taylor B,et a1.Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulm-onary disease in the United States,1998-2008[J].Am J Respir Grit Gare Med,2012,185(2):152-159.
[10]Salman A,Milbrandt EB,Pinsky MR,et a1.The role ofnoninvasive ventilation in acute cardiogenic pulmonary edema[J].Grit Care,2010,14(2):303-308.
[11]姚睿.拒绝气管插管的AECOPD并严重呼吸性酸中毒及意识障碍患者行无创正压通气治疗的疗效分析[J].临床医学研究与实践,2017,2(34):59-60.
[12]全新玉.拒绝气管插管的慢性阻塞性肺疾病急性加重并严重呼吸性酸中毒及意识障碍患者行无创正压通气治疗的疗效分析[J].中国实用医学,2017,12(25):67-68.
[13]吴春风,崔佰君.拒绝气管插管的慢性阻塞性肺疾病急性加重并严重呼吸性酸中毒及意识障碍患者行无创正压通气治疗的疗效分析[J].中国老年学杂志,2015,35(23):6810-6811.
[14]中国医师协会急诊医师分会,中国医疗保健国际交流促进会急诊急救分会,国家卫生健康委能力建设与继续教育中心急诊学专家委员会.无创正压通气急诊临床实践专家共识(2018)[J].中华急诊医学杂志,2019,28(1):14-24.
[15]李报春,刘大锐,王海艳,等.无创正压通气治疗慢性阻塞性肺疾病急性加重合并重度呼吸性酸中毒[J].实用医药杂志,2014,31(12):1082-1083.
[16]梁世康,高兴华,赵献连.无创正压通气治疗COPD伴Ⅱ型呼吸衰竭疗效观察[J].临床肺科杂志,2008,13(6):701-702.