经鼻高流量加温湿化吸氧治疗在慢性阻塞性肺病合并呼吸衰竭患者中应用的疗效观察

发布时间：2018-02-28 03:52

本文关键词： 经鼻高流量加温湿化吸氧治疗慢性阻塞性肺疾病呼吸衰竭二氧化碳潴留　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究经鼻高流量加温湿化吸氧治疗(HFNC)对慢性阻塞性肺病(COPD)合并呼吸衰竭患者的治疗效果。方法:选取COPD患者合并呼吸衰竭患者72例,随机分为两组,每组36例,两组患者均给予常规抗感染、解痉、化痰、抑制气道炎症及纠正电解质紊乱等治疗,治疗组在常规治疗基础上加用经鼻高流量加温湿化吸氧治疗仪,对照组在常规治疗上加用持续低流量鼻导管氧气吸入,观察两组患者治疗前后的临床症状、呼吸频率、心率、PH值、PaCO2、PaO2、SaO2以及不良反应。结果:两组患者治疗后呼吸频率、心率、PaCO2均较治疗前下降(P0.05),PaO2、SaO2均较治疗前上升(P0.05),对照组PH值在治疗前后无明显改善(P0.05),治疗组PH值治疗前后有所改善(P0.05),治疗组治疗后呼吸频率下降程度高于对照组(P0.05),PaCO2下降程度高于对照组(P0.05),两组患者治疗后的心率、PH值、PaO2、SaO2无明显差异(P0.05)。治疗组治疗后述痰液稀释易咳出24例,对照组治疗后述痰液稀释易咳出13例,治疗组明显高于对照组。对照组有9例患者(25%)诉鼻部干燥不适,4例患者(11%)因二氧化碳分压过高予以无创通气,治疗组有13例患者(36%)感鼻腔气流量过大,2例患者(5.5%)因二氧化碳分压过高予以无创通气。结论:经鼻高流量加温湿化吸氧治疗对于COPD合并呼吸衰竭(伴有轻度二氧化碳潴留)患者有良好的治疗效果,能减慢患者呼吸频率、降低PaCO2、改善患者症状、稀释痰液,在治疗过程中需严密监测患者症状及血气分析,必要时予以机械通气。
[Abstract]:Objective: to study the therapeutic effect of high flow rate of nasal hyperthermia and humidification oxygen inhalation on chronic obstructive pulmonary disease (COPD) patients with respiratory failure. Methods: 72 patients with COPD complicated with respiratory failure were randomly divided into two groups, 36 cases in each group. Two groups of patients were treated with routine anti-infection, spasmolysis, phlegm, inhibition of airway inflammation and correction of electrolyte disorder. The patients in the control group were treated with continuous low-flow nasal catheter oxygen inhalation. The clinical symptoms, respiratory frequency, heart rate and PH value of Paco _ 2 Pao _ 2O _ 2 SaO2 and adverse reactions were observed before and after treatment in both groups. Heart rate Paco _ 2 was lower than that before treatment (P 0.05) and PaO _ 2SaO _ 2 was higher than that before treatment. The PH value of control group had no significant improvement before and after treatment. The PH value of treatment group was improved before and after treatment, and the respiratory frequency of treatment group was higher than that of control group (P 0.05 PaCO _ 2) before and after treatment. The degree of decrease of respiratory frequency in treatment group was higher than that in control group before and after treatment. The degree of decrease was higher than that of the control group (P 0.05). There was no significant difference in the PH value of heart rate and Pao 2 / SaO2 between the two groups after treatment. 24 cases of sputum dilution were easy to cough after treatment in the treatment group. In the control group, the sputum was easy to cough up in 13 cases, which was obviously higher in the treatment group than in the control group. In the control group, 9 cases (25 cases) complained of nasal dryness and discomfort, 4 cases (11 cases) were given noninvasive ventilation due to excessive partial pressure of carbon dioxide. In the treatment group, 13 patients (36%) felt that the nasal cavity gas flow was too large and 2 cases were treated with non-invasive ventilation due to the excessive partial pressure of carbon dioxide. Conclusion: the treatment of COPD with respiratory failure (accompanied by mild dioxia) through nasal hyperflow and humidification with oxygen inhalation is effective in the treatment of non-invasive ventilation. Carbon trapping) patients have a good therapeutic effect, It can slow down the respiratory rate, decrease Paco _ 2, improve the symptoms, dilute the sputum, and monitor the symptoms and blood gas analysis closely during the treatment, and give mechanical ventilation if necessary.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9;R563.8

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