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黄颂平 陈冬冬 蔡志明 沈冰寒 叶晓艺.无创正压通气治疗不同表型慢性阻塞性肺疾病急性加重期合并呼吸衰竭的临床疗效[J].中国现代医生,2021,59(29):28-31+35
无创正压通气治疗不同表型慢性阻塞性肺疾病急性加重期合并呼吸衰竭的临床疗效
Clinical efficacy of non-invasive positive pressure ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease with respiratory failure of different phenotypes
  
DOI:
中文关键词:  慢性阻塞性肺疾病  表型  无创正压通气  呼吸衰竭
英文关键词:Chronic obstructive pulmonary disease  Phenotype  Non-invasive positive pressure ventilation  Respiratory failure
基金项目:福建省泉州市科技计划项目(2O17Z037)
作者单位
黄颂平 陈冬冬 蔡志明 沈冰寒 叶晓艺 福建医科大学附属泉州第一医院呼吸与危重症医学科福建泉州 362000 
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中文摘要:
      目的 探讨无创正压通气(NPPV)治疗不同表型慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者的临床疗效。方法 选择我院2018 年5 月至2020 年5 月收治的AECOPD 合并呼吸衰竭患者143 例,根据过去1 年急性加重次数分为非频繁急性加重(<2 次/年)组71 例和频繁急性加重(≥2 次/年)组72 例。按照随机分组法,非频繁急性加重组分为对照组非频繁型(常规治疗)36 例和观察组非频繁型(常规治疗+NPPV)35 例;频繁急性加重组分为对照组频繁型(常规治疗)36 例和观察组频繁型(常规治疗+NPPV)36 例。观察血气指标变化和NPPV 治疗效果及合并症的构成情况。结果 观察组非频繁型治疗24 h、3 d 和7 d 时血气指标与对照组非频繁型比较,差异无统计学意义(P>0.05);观察组频繁型经NPPV 治疗24 h、3 d 和7 d 时pH 值、PaCO2 和PaO2 与对照组频繁型比较,差异有统计学意义(P<0.05)。对于采用NPPV 治疗的AECOPD 合并呼吸衰竭患者,频繁急性加重组患者的24 h、3 d 和7 d 时pH 值、PaCO2 和PaO2 与非频繁急性加重组比较,差异有统计学意义(P<0.05)。频繁急性加重组合并睡眠呼吸暂停低通气综合征(SAHS)较非频繁急性加重组明显增多(26.39% vs.11.27%),差异有统计学意义(P<0.05)。结论 对于频繁急性加重表型的AECOPD 并呼吸衰竭患者,尤其是合并SAHS 患者,建议尽早行无创正压通气治疗,以期获得更好的临床效果。
英文摘要:
      Objective To investigate the clinical efficacy of non-invasive positive pressure ventilation(NPPV)in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with respiratory failure of different phenotypes.Methods A total of 143 patients with AECOPD complicated with respiratory failure admitted to our hospital from May 2018 to May 2020 were selected and divided into infrequent acute exacerbation group(<2 times/year,n=71)and frequent acute exacerbation group(≥2 times/year,n=72)according to the number of exacerbations in the past year.According to the randomization method,the infrequent acute exacerbation group consisted of 36 cases of infrequent exacerbation in the control group(conventional treatment)and 35 cases of infrequent exacerbation in the observation group(conventional treatment+NPPV).The frequent exacerbation group consisted of 36 cases of frequent exacerbation(conventional treatment)in the control group and 36 cases of frequent exacerbation(conventional treatment+NPPV)in the observation group.The changes in blood gas parameters and the therapeutic effect of NPPV,and the composition of complications were observed.Results There was no significant difference in blood gas indexes of the infrequent exacerbation between the observation and control groups at 24 h,3 d,and 7 d after treatment(P>0.05).There were significant differences in pH value,PaCO2,and PaO2 of the frequent exacerbation between the observation and control groups at 24 h,3 d,and 7 d after NPPV treatment(P<0.05).For AECOPD patients with respiratory failure treated with NPPV,there were significant differences in pH,PaCO2 and PaO2 at 24 hours,3 days and 7 days between frequent acute exacerbation group and non-frequent acute exacerbation group(P<0.05).The combination of sleep apnea-hypopnea syndrome(SAHS)in the frequent acute exacerbation group was significantly increased compared with that in the infrequent acute exacer bation group(26.39% vs.11.27%),and the difference had statistical significance(P<0.05).Conclusion For patients with AECOPD and respiratory failure with frequent acute exacerbation phenotype,especially those with SAHS,non-invasive positive pressure ventilation is recommended as early as possible in order to obtain better clinical results.
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