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

发布时间：2018-11-04 13:53

【摘要】：目的探讨侧卧位通气在有创通气治疗慢性阻塞性肺疾病(简称慢阻肺)急性加重患者中的临床意义。方法 2014年10月至2016年12月,抽样选取我科收治的慢阻肺急性加重行有创通气治疗患者60例,符合纳入标准,随机分为治疗组(n=30)和对照组(n=30)。两组患者均进行药物祛痰、平喘、抗感染、有创通气、振动排痰、纤维支气管镜(简称纤支镜)、镇痛、镇静、营养支持、重症监护等治疗,治疗组有创通气时采用侧卧位通气,对照组采用半侧卧位通气。观察两组患者有创通气前和有创通气1 d后动脉血pH、动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_2)、动脉血氧合指数(PaO_2/FiO_2)、心率(heart rate,HR)、呼吸(respiratory rate,R)、气道阻力(air way resistance,Raw),统计两组患者肺部感染控制(control of pulmonary infection,PIC)窗时间、有创通气时间、机械通气总时间及住重症医学科(intensivecare unit,ICU)时间。结果与通气前比较,通气1 d后两组患者pH及PaO_2/FiO_2均升高,PaCO_2、HR、R及Raw均降低,差异有统计学意义(P0.05)。通气1 d后,治疗组与对照组患者pH[(7.43±0.07比7.37±0.11,P0.05)]、PaO_2/FiO_2[(253.52±65.33)mm Hg(1 mm Hg=0.133 kPa)比(215.46±58.72)mm Hg,P0.05)]及PaCO_2[(52.45±7.15)mm Hg比(59.39±8.44)mm Hg,P0.01)]比较,差异有统计学意义,HR、R及Raw比较,差异无统计学意义(P0.05)。与对照组比较,治疗组PIC窗时间[(3.7±1.4)d比(5.3±2.2)d,P0.01)]、有创通气时间[(4.0±1.5)d比(6.1±3.0)d,P0.01)]、机械通气总时间[(4.7±2.0)d比(7.3±3.7)d,P0.01)]及住ICU时间[(6.2±2.1)d比(8.5±4.2)d,·P0.01)]均缩短,差异有统计学意义。结论慢阻肺急性加重患者有创通气时采用侧卧位通气,能够有效改善动脉血气指标,降低Raw,缩短PIC窗时间、有创通气时间、机械通气总时间及住ICU时间。
[Abstract]:Objective to investigate the clinical significance of lateral position ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD) by invasive ventilation. Methods from October 2014 to December 2016, 60 patients with acute exacerbation of COPD treated by invasive ventilation were randomly divided into treatment group (n = 30) and control group (n = 30). The patients in both groups were treated with drug expectorant, antiasthmatic, anti-infection, invasive ventilation, vibration sputum drainage, fiberoptic bronchoscopy, analgesia, sedation, nutritional support, intensive care, etc. The treatment group was treated with lateral position ventilation and the control group with half lateral position ventilation. The arterial pH, arterial partial pressure of carbon dioxide (arterial partial pressure of carbon dioxide,PaCO_2), arterial oxygenation index (PaO_2/FiO_2) and heart rate (heart rate,HR) were observed before and 1 day after invasive ventilation in both groups. Respiratory (respiratory rate,R), airway resistance (air way resistance,Raw), window time of pulmonary infection control (control of pulmonary infection,PIC), time of invasive ventilation, total time of mechanical ventilation and time of staying in intensive care department (intensivecare unit,ICU) were counted. Results compared with those before ventilation, pH and PaO_2/FiO_2 increased, PaCO_2,HR,R and Raw decreased in two groups after 1 day of ventilation (P0.05). After 1 day of ventilation, pH in treatment group and control group [(7.43 卤0.07 vs 7.37 卤0.11p0.05)], PaO_2/FiO_2 [(253.52 卤65.33) mm Hg (1 mm Hg=0.133 kPa) vs (215.46 卤58.72) mm Hg,] Compared with PaCO_2 [(52.45 卤7.15) mm Hg vs (59.39 卤8.44) mm Hg,P0.01)], the difference was statistically significant, but HR,R and Raw had no statistical significance (P0.05). Compared with the control group, the PIC window time was (3.7 卤1.4) d vs (5.3 卤2.2) dP0.01, and the invasive ventilation time was (4.0 卤1.5) d vs (6.1 卤3.0) dP0.01 in the treatment group. The total time of mechanical ventilation [(4.7 卤2.0) days vs (7.3 卤3.7) d, P0.01] and the duration of living ICU [(6.2 卤2.1) days vs (8.5 卤4.2) days, P 0.01] were shortened, and the difference was statistically significant. Conclusion Lateral position ventilation in patients with acute exacerbation of COPD can effectively improve arterial blood gas index, reduce Raw, shortening PIC window time, invasive ventilation time, total mechanical ventilation time and ICU residence time.
【作者单位】：达州市中心医院重症医学科;
【分类号】：R563.9

【相似文献】