不同氧流量驱动肝素雾化吸入对AECOPD机械通气患者呼吸力学的影响

发布时间：2018-02-10 11:40

本文关键词： 雾化吸入肝素氧流量慢性阻塞性肺疾病呼吸力学　出处：《石河子大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的通过监测AECOPD机械通气患者气道峰压(Ppeak)、平台压(Pplat)、动态顺应性(Cd)和吸气阻力(Raw)、血气分析及凝血功能水平的变化，比较不同氧流量驱动肝素雾化吸入对AECOPD机械通气患者呼吸力学的影响，观察对患者呼吸力学改善效果，寻找合适的氧流量。为AECOPD患者机械通气选择雾化吸入时恰当的氧流量提供理论参考依据。方法选取51例AECOPD机械通气患者，按照雾化吸入时不同氧流量将患者随机分为三组：5L/min(A组15例)，7L/min (B组17例)，9L/min (C组15例)。分别于雾化吸入前，雾化后30min、1d、3d、7d各个时间点监测患者气道峰压(Ppeak)、平台压(Pplat)、动态顺应性(Cd)和吸气阻力(Raw)、血气分析及凝血功能相关指标。采用SPSS17.0统计软件进行统计学处理，所有计量资料以均数±标准差(x S)表示，，不同氧流量雾化吸入重复测量资料比较采用重复测量资料方差分析。结果AECOPD患者行机械通气雾化吸入肝素后，不同氧流量水平下三组患者呼吸力学比较差异有统计学意义(P0.05)，其中B组呼吸力学与A、C两组比较差异均有统计学意义(P0.05)，A组与C组比较差异无统计学意义(P0.05)。同一组不同监测时间点比较，与雾化前相比，B组雾化后各个时间点呼吸力学参数变化明显，差异有统计学意义(P0.05)；A组雾化30min后，各个呼吸力学指标与雾化前相比有统计学意义(P0.05)，而C组雾化前后改变不明显(P0.05)。不同氧流量驱动肝素雾化吸入，三组患者活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)在雾化前、第7天比较差异均无统计学意义(P0.05)。结论不同氧流量驱动肝素雾化吸入治疗AECOPD机械通气患者时，采用7L/min氧流量驱动肝素雾化吸入治疗效果方面优于5L/min和9L/min的氧流量。可有效降低患者气道峰压、平台压、吸气阻力，增加胸肺动态顺应性，达到最佳雾化效果。7L/min氧流量驱动肝素雾化吸入治疗AECOPD机械通气患者，有利于机械通气的执行和通气效果的提高，而且方法简便易行。对AECOPD机械通气患者采用肝素雾化吸入治疗是安全有效的，三组患者在雾化结束后，未见明确的肝素相关的副作用，值得临床推广应用。
[Abstract]:Objective to investigate the changes of peak airway pressure (Ppeaka), platform pressure (platinus), dynamic compliance (CD) and inspiratory resistance (R), blood gas analysis and coagulation function in patients with AECOPD mechanical ventilation. To compare the effect of heparin atomization inhalation with different oxygen flow rate on respiratory mechanics in patients with AECOPD mechanical ventilation, and observe the effect of improving respiratory mechanics on patients. To find the appropriate oxygen flow rate and to provide theoretical reference for the selection of oxygen flow rate in mechanical ventilation of AECOPD patients. Methods 51 patients with AECOPD mechanical ventilation were randomly divided into three groups according to different oxygen flow rate during atomization inhalation: 15 cases in group A and 15 cases in group B, 17 cases in group C, 17 cases in group C, and 15 cases in group C before nebulization. The peak airway pressure (Ppeaka), platform-pressure (platinia), inspiratory resistance, blood gas analysis and clotting function were monitored at 30 min, 1 d and 3 d / 7 d after nebulization. SPSS17.0 software was used for statistical analysis. All the measured data were expressed as mean 卤standard deviation (x S). The repeated measurement data of different oxygen flow rates were compared by the analysis of variance of repeated measurement data. Results the patients with AECOPD were treated with nebulized heparin by mechanical ventilation. There were significant differences in respiratory mechanics between the three groups under different oxygen flow levels (P 0.05). There was no significant difference in respiratory mechanics between group B and group A (P 0.05) and group C (P 0.05), but there was no significant difference between group A and group C (P 0.05), but there was no significant difference between group A and group C (P 0.05). Compared with monitoring time points, Compared with those before and after atomization, the respiratory mechanical parameters of group B changed obviously at each time point after atomization, and the difference was statistically significant after 30 minutes of atomization in group A (P 0.05). Compared with before atomization, the indexes of respiratory mechanics had statistical significance (P 0.05), but the change of group C was not obvious before and after atomization (P 0.05). Different oxygen flow rate driven heparin atomization inhalation, while in group C there was no significant change before and after atomization. There was no significant difference in activated partial thromboplastin time (APTT), prothrombin time (PTT) and fibrinogen (FB) between the three groups on the 7th day before atomization. Conclusion in the treatment of AECOPD patients with mechanical ventilation with different oxygen flow rate driven heparin atomization inhalation, the effect of 7L / min oxygen flow driven heparin atomization inhalation is better than that of 5L / min and 9L / min, which can effectively reduce the peak airway pressure and plateau pressure. Inspiratory resistance increased the dynamic compliance of chest and lung, and achieved the best atomization effect. 7 L / min oxygen flow driven heparin atomization inhalation in AECOPD patients, which was beneficial to the execution of mechanical ventilation and the improvement of ventilation effect. It is safe and effective to use heparin atomization inhalation in the patients with AECOPD mechanical ventilation. After the nebulization, there are no definite side effects of heparin in the three groups, so it is worth popularizing and applying in clinic.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R473.5

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