无创正压机械通气对老年慢性肺心病伴Ⅱ型呼吸衰竭患者的疗效观察
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摘要
目的回顾性分析无创正压机械通气对老年慢性肺心病右心功能不全并伴有Ⅱ型呼吸衰竭患者的治疗效果。方法选择我院因慢性肺心病右心功能不全并伴有Ⅱ型呼吸衰竭入院治疗的患者83例,随机分为2组,2组患者在采用相同常规治疗方案治疗基础上,对照组给予鼻导管低流量吸氧,观察组给予无创正压机械通气治疗,比较2组临床疗效,同时观察2组患者治疗前、治疗后72 h的心率(HR)、呼吸频率(RR)、pH、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、N末端脑钠素原(NT-proBNP)、颈静脉的充盈或怒张、肝脏肿大、双下肢水肿、体质量的变化及胸片的改善情况。结果治疗72 h后,观察组临床总有效率为90.5%,明显高于对照组(70.7%),差异具有统计学意义(P=0.023)。2组患者经过治疗后,HR、RR、动脉血气分析指标(pH、PaO_2、PaCO_2)及NT-proBNP均有显著改善(P<0.05),且观察组改善更显著;观察组的插管率为4.8%,对照组为9.8%,2组差异无统计学意义(P>0.05);观察组住院死亡率为2.4%,对照组为19.5%,差异有统计学意义(P<0.05);观察组住院时间与对照组比较显著缩短(P<0.05)。结论采用包括无创正压机械压通气在内的综合疗法治疗老年慢性肺心病右心功能不全并伴有Ⅱ型呼吸衰竭的患者,能够更快地纠正患者的缺氧和二氧化碳潴留的状态,降低血浆NT-proBNP水平,改善患者的肺功能及心功能,降低住院时间,减少死亡率。
Objective To study the clinical efficacy of noninvasive positive pressure mechanical ventilation on type Ⅱrespiratory failure in the elderly patients with chronic pulmonary heart disease. Methods A retrospective analysis was conducted,eighty-three elderly inpatients of chronic pulmonary heart disease with type Ⅱ respiratory failure were recruited. All subjects were divided into two groups according whether using the noninvasive positive pressure mechanical ventilation on the basis of routine treatment. Both groups were given the same routine treatment.The control group was given low flow oxygen uptake with nasal catheter,and the observation group was treated with noninvasive positive pressure mechanical ventilation on the basis of routine treatment. The clinical efficacy,heart rate( HR) of 72 h after treatment,respiratory rate( RR),arterial blood gas index( pH,PaO_2,PaCO_2),NT-proBNP,jugular vein filling,percussion pain of hepatic region and( or) swelling of liver,edema of both lower limbs legs,variation of weight and the improvement of DR were observed and compared between two groups. Results Total effective rate in observation group 72 h after treatment was 90. 5%,apparently higher than that in control group( 70. 7%),and there was significant difference between two groups( P = 0. 023). HR,RR,p H,PaO_2,PaCO_2 and the level of NT-proBNP were improved in two groups after treatment( P< 0. 05),especially in observation group( P< 0. 05). The rate of tube incubation in observation group was 4. 8%,while it was 9. 8% in the control group( P>0. 05).The fatality rate of observation group was 2. 4%,and it was 19. 5% in control group,which was of significant difference between the two groups( P<0. 05). The length of hospital stay of observation group was significantly shorter than that of control group. Conclusions The use of the synthesize therapy including noninvasive positive pressure mechanical ventilation in treating the elderly patients with chronic pulmonary heart disease with type Ⅱrespiratory failure can correct the state of oxygen deficit,store up of carbon dioxide fastly,lower the level of NTproBNP,improve the cardiac and pulmonary function,reduce the length of hospital stay and the mortality rate.
Objective To study the clinical efficacy of noninvasive positive pressure mechanical ventilation on type Ⅱrespiratory failure in the elderly patients with chronic pulmonary heart disease. Methods A retrospective analysis was conducted,eighty-three elderly inpatients of chronic pulmonary heart disease with type Ⅱ respiratory failure were recruited. All subjects were divided into two groups according whether using the noninvasive positive pressure mechanical ventilation on the basis of routine treatment. Both groups were given the same routine treatment.The control group was given low flow oxygen uptake with nasal catheter,and the observation group was treated with noninvasive positive pressure mechanical ventilation on the basis of routine treatment. The clinical efficacy,heart rate( HR) of 72 h after treatment,respiratory rate( RR),arterial blood gas index( pH,PaO_2,PaCO_2),NT-proBNP,jugular vein filling,percussion pain of hepatic region and( or) swelling of liver,edema of both lower limbs legs,variation of weight and the improvement of DR were observed and compared between two groups. Results Total effective rate in observation group 72 h after treatment was 90. 5%,apparently higher than that in control group( 70. 7%),and there was significant difference between two groups( P = 0. 023). HR,RR,p H,PaO_2,PaCO_2 and the level of NT-proBNP were improved in two groups after treatment( P< 0. 05),especially in observation group( P< 0. 05). The rate of tube incubation in observation group was 4. 8%,while it was 9. 8% in the control group( P>0. 05).The fatality rate of observation group was 2. 4%,and it was 19. 5% in control group,which was of significant difference between the two groups( P<0. 05). The length of hospital stay of observation group was significantly shorter than that of control group. Conclusions The use of the synthesize therapy including noninvasive positive pressure mechanical ventilation in treating the elderly patients with chronic pulmonary heart disease with type Ⅱrespiratory failure can correct the state of oxygen deficit,store up of carbon dioxide fastly,lower the level of NTproBNP,improve the cardiac and pulmonary function,reduce the length of hospital stay and the mortality rate.
引文
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[9]王雪峰,袁梅,蔡志芳.老年慢性肺源性心脏病失代偿期患者使用无创呼吸机的疗效观察[J].实用老年医学,2014,28(10):851-852.
[10]Park SY,Lee CY,Jang SH,et al.One-year prognosis and the role of brain Natriuretic Peptide Levels in patients with chromic cor Pulmonary[J].J Korean Med Sci,2015,30(4):442-449.
[11]Leuchte HH,Holzapfel M,Baumgartner RA.Clinical significance of brain natriuretic in primary pulmonary hypertension[J].J Am Coll Cardiol,2014,43(5):746-770.
[12]王孝芹,于晓明,刘华杰,等.N-端脑钠肽前体和糖类抗原125检测在慢性肺源性心脏病失代偿期患者中的临床意义[J].国际检验医学杂志,2015,36(2):267-268.
[13]牛华,方浩微,王云,等.N-末端脑钠肽前体在AECOPD合并肺心病诊治中的价值[J].临床肺科杂志,2014,(9):13.
[2]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.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(1):255-264.
[3]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(2014修订版)[J].国际呼吸杂志,2014,34(1):1-11.
[4]彭红星,杨荣时,曾玉兰.无创双水平正压通气治疗老年慢性肺源性心脏病合并呼吸衰竭的疗效观察[J].实用老年医学,2013,27(8):676-678.
[5]刘发堂.无创机械通气治疗慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭的临床疗效[J].医学临床研究,2013,15(11):2179-2180,2183.
[6]中华医学会呼吸病学会呼吸生理与重症监护学组.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(1):86-98.
[7]肖丽娟.Bi PAP无创机械通气在呼吸衰竭救治中的作用[J].医学临床研究,2011,28(4):69.
[8]郭慧峰,杨敬业,张省亮,等.双水平气道正压通气对慢性充血性心力衰竭患者氨基末端脑钠肽前体的影响[J].实用老年医学,2010,24(2):144-146.
[9]王雪峰,袁梅,蔡志芳.老年慢性肺源性心脏病失代偿期患者使用无创呼吸机的疗效观察[J].实用老年医学,2014,28(10):851-852.
[10]Park SY,Lee CY,Jang SH,et al.One-year prognosis and the role of brain Natriuretic Peptide Levels in patients with chromic cor Pulmonary[J].J Korean Med Sci,2015,30(4):442-449.
[11]Leuchte HH,Holzapfel M,Baumgartner RA.Clinical significance of brain natriuretic in primary pulmonary hypertension[J].J Am Coll Cardiol,2014,43(5):746-770.
[12]王孝芹,于晓明,刘华杰,等.N-端脑钠肽前体和糖类抗原125检测在慢性肺源性心脏病失代偿期患者中的临床意义[J].国际检验医学杂志,2015,36(2):267-268.
[13]牛华,方浩微,王云,等.N-末端脑钠肽前体在AECOPD合并肺心病诊治中的价值[J].临床肺科杂志,2014,(9):13.