俯卧位通气联合雾化吸入治疗AECOPD的临床效果
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摘要
目的观察俯卧位通气治疗AECOPD的临床效果。方法选取2015年10月～2017年5月转入ICU的AE COPD患者60例为研究对象,将其随机分成两组,其中实验组30例,给予俯卧位通气联合雾化吸入;对照组30例,给予仰卧位通气联合雾化吸入。监测动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2),氧合指数(PaO_2/FiO_2),生命体征进行监测;监测感染指标包括白细胞计数(WBC)、降钙素原(PCT)、患者痰液量和性状变化。结果两组间PaO_2、PaO_2/FiO_2比较差异有统计学意义(P<0.05);两组间WBC、PCT、痰液引出量比较差异有统计学意义(P<0.05);两组有创呼吸机使用时间、ICU住院时间比较差异有统计学意义(P<0.05)。结论俯卧位通气在改善AECOPD患者氧合、加速痰液引流方面优于仰卧位通气,有创呼吸机使用时间和ICU住院日有所缩短。
Objective To observe the clinical effect of prone position ventilation in the treatment of AECOPD. Methods60 patients with AECOPD who were transferred to the ICU from October 2015 to May 2017 were enrolled and randomly divided into the experimental group of 30 patients who were given the prone position ventilation combined with aerosol inhalation, and the control group of 30 patients who were given supine position ventilation combined with aerosol inhalation. The arterial oxygen partial pressure(PaO_2), arterial blood carbon dioxide partial pressure(PaCO_2), oxygenation index(PaO_2/FiO_2), vital signs and the infection indicators including white blood cell count(WBC), procalcitonin(PCT), the changes of patients sputum volume and traits were monitored between the two groups. Results There were statistically significant differences in PaO_2 and PaO_2/FiO_2 between the two groups(P<0.05). The differences in WBC, PCT and sputum extraction were statistically significant between the two groups(P<0.05). There were statistically significant differences in the inoperative ventilator use time and ICU hospitalization time between the two groups(P<0.05). Conclusion Prone position ventilation is superior to supine position ventilation in improving oxygenation and accelerating sputum drainage in patients with AECOPD. And in the former case, the use time of invasive ventilator and ICU hospitalization day are shortened.
Objective To observe the clinical effect of prone position ventilation in the treatment of AECOPD. Methods60 patients with AECOPD who were transferred to the ICU from October 2015 to May 2017 were enrolled and randomly divided into the experimental group of 30 patients who were given the prone position ventilation combined with aerosol inhalation, and the control group of 30 patients who were given supine position ventilation combined with aerosol inhalation. The arterial oxygen partial pressure(PaO_2), arterial blood carbon dioxide partial pressure(PaCO_2), oxygenation index(PaO_2/FiO_2), vital signs and the infection indicators including white blood cell count(WBC), procalcitonin(PCT), the changes of patients sputum volume and traits were monitored between the two groups. Results There were statistically significant differences in PaO_2 and PaO_2/FiO_2 between the two groups(P<0.05). The differences in WBC, PCT and sputum extraction were statistically significant between the two groups(P<0.05). There were statistically significant differences in the inoperative ventilator use time and ICU hospitalization time between the two groups(P<0.05). Conclusion Prone position ventilation is superior to supine position ventilation in improving oxygenation and accelerating sputum drainage in patients with AECOPD. And in the former case, the use time of invasive ventilator and ICU hospitalization day are shortened.
引文
[1]王洪州,邓丽娟.慢性阻塞性肺疾病急性加重机械通气患者早期目标导向镇静的临床研究[J].中国医药导报,2017,14(28):74-77.
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[10]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)诊治中国专家共识(2014年修订版)[J].国际呼吸杂志,2014,34(1):1-11.
[11]孙文清,郝金柱,郭帅.压缩雾化吸人、振动排痰配合无创通气治疗慢性阻塞性肺疾病急性加重期伴呼吸衰竭的临床观察[J].临床荟萃,2008,23(14):1034-1035.
[12]Galiatsou E,Kostanti E,Svarna E,et al.Prone position augments recruitment and prevents alveolar overinflation in acute lung injury[J].Am J Respir Crit Care Med,2006,174:187-197.
[13]王天.俯卧位机械通气治疗慢性阻塞性肺病患者脱机困难对氧合的影响[J].岭南急诊医学杂志,2017,22(1):30-42.
[14]刘小毅,刘慧.侧卧位通气在有创通气治疗慢性阻塞性肺疾病急性加重患者中的应用观察[J].中国呼吸与危重监护杂志,2017,16(6):540-542.
[15]翟翠,兀小娟.慢性阻塞性肺疾病急性加重表型的研究进展[J].中华肺部疾病杂志(电子版),2018,10(5):613-616.
[16]Feng E,Wan R,Yang S,et al.Expression levels of induced sputum IL-8 and IL-10 and drug intervention effects in patients acute exacerbated COPD complicated with chronic cor at high altitude[J].Exp Ther Med,2013,6(3):747-758.
[2]Gursel G.Determinants of the length of mechanical ventilation in patients with COPD in the intensive careunit[J].Respiration,2005,72(1):61-67.
[3]王砚东,钟海,郭勇,等.纤维支气管镜在急诊急救中的应用[J].中国临床研究,2010,5(2):78-79.
[4]Vestbo J,Hurd SS,Agusti AG,et al.Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease[J].Am J Respir Crit Care Med,2013,187(4):347-365.
[5]文富强.2017年慢性阻塞性肺疾病全球创议再解读[J].华西医学,2018,33(1):23-27.
[6]Wedzicha JA Ers Co-Chair,Miravitlles M,Hurst JR,et al.Management of COPD exacerbations:A European respiratory society American thoracic society guideline[J].Eur Respir J,2017,49(3):1600791.
[7]Decramer M,Janssens W,Miravitlles M.Chronic obstructive pulmonary disease[J].Lancet,2012,379(9823):1341-1351.
[8]Steer J,Normane M,Afolabio A,et al.Dyspnoea severity and pneumonia as predictors of in-hospital mortality and early readmission in acute exacerbations of COPD[J].Thorax,2012,67(2):117-121.
[9]黄培飞.80例机械通气合并肺部感染患者纤维支气管镜气道灌洗价值研究[J].现代诊断与治疗,2016,27(13):2451-2453.
[10]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)诊治中国专家共识(2014年修订版)[J].国际呼吸杂志,2014,34(1):1-11.
[11]孙文清,郝金柱,郭帅.压缩雾化吸人、振动排痰配合无创通气治疗慢性阻塞性肺疾病急性加重期伴呼吸衰竭的临床观察[J].临床荟萃,2008,23(14):1034-1035.
[12]Galiatsou E,Kostanti E,Svarna E,et al.Prone position augments recruitment and prevents alveolar overinflation in acute lung injury[J].Am J Respir Crit Care Med,2006,174:187-197.
[13]王天.俯卧位机械通气治疗慢性阻塞性肺病患者脱机困难对氧合的影响[J].岭南急诊医学杂志,2017,22(1):30-42.
[14]刘小毅,刘慧.侧卧位通气在有创通气治疗慢性阻塞性肺疾病急性加重患者中的应用观察[J].中国呼吸与危重监护杂志,2017,16(6):540-542.
[15]翟翠,兀小娟.慢性阻塞性肺疾病急性加重表型的研究进展[J].中华肺部疾病杂志(电子版),2018,10(5):613-616.
[16]Feng E,Wan R,Yang S,et al.Expression levels of induced sputum IL-8 and IL-10 and drug intervention effects in patients acute exacerbated COPD complicated with chronic cor at high altitude[J].Exp Ther Med,2013,6(3):747-758.
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