摘要
目的：比较小潮气量和常规潮气量机械通气治疗老年慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭的临床疗效。方法88例老年COPD合并Ⅱ型呼吸衰竭患者随机分为两组，A组（n=44例）采用小潮气量（6ml/kg）机械通气治疗，B组（n=44例）采用常规潮气量（10ml/kg）机械通气治疗，比较两组患者机械通气治疗前后动脉血气指标（pH、PaO2、PaCO2）变化情况，机械通气治疗0.5h、24h的气道压力指标气道峰压（Ppk）、平台压（Pplat）、内源性呼气末正压（PEEPi）变化情况以及气压伤发生率、存活率、机械通气时间、平均住院时间。结果两组患者经机械通气治疗后血气指标较治疗前均明显改善（P〈0.05）。治疗后B组pH（7.44±0.05）、PaO2（10.12±1.34）明显高于A组（7.37±0.07），（8.51±1.23）（P〈0.05），PaCO2（4.81±1.03）明显低于A组（6.77±1.14）（P〈0.05）。B组患者机械通气0.5h气道Ppk、Pplat、PEEPi水平[（4.50±0.72）、（3.60±0.76）、（1.07±0.20）]均明显高于A组患者0.5h[（3.67±0.65）、（3.04±0.57）、（0.80±0.15）]（P〈0.05）；B组患者机械通气24h时气道Ppk、Pplat、PEEPi水平[（4.27±0.54）、（3.58±0.67）、（0.95±0.11）]均明显高于A组24h患者[（3.62±0.76）、（2.92±0.72）、（0.72±0.22）]（P〈0.05）。A组气压伤发生率（0%）明显低于B组（18.2%）（P〈0.05），机械通气时间和平均住院时间（7.5±3.4），（12.7±4.2）较B组（12.2±5.1），（17.3±6.5）明显缩短（P〈0.05），而存活率（84.1%vs77.3%）比较无显著性差异（P〉0.05）。结论小潮气量机械通气治疗老年COPD合并Ⅱ型呼吸衰竭患者可明显减轻或避免肺组织损伤，是一种有效的肺保护性机械通气治疗措施，值得临床推广应用。
Objective To compare the therapeutic effects of the two different tidal volume of mechanical ventilation for the treatment of COPD combining typeⅡrespiratory failure in eld patients. Methods 88 cases of old patients with COPD combining typeⅡ respiratory failure were randomly devided into two groups. Group A（n=44）used small tiedal volume（6ml/kg）mechanical ventilation,group B（n=44）uese conventional tiedal volume. The changes of arterial blood gas after treatment were compared （pH、PaO2、PaCO2）,0.5 h and 24h after mechanical ventilation, the changes of air way pressure index of Ppk、Pplat、PEEPi and the pressure injury, survival rate, mechanical ventilation duration and average hospital stay were compared. Results The index of blood gas of both groups were improved after the treatment（P〈0.05）.The pH value and PaO2 of B group B （7.44±0.05）、PaO2 was significantly higher than those in group A（（7.37±0.07）,（8.51±1.23）（P〈0.05）,respectively, and the PaCO2 was signifcanlty lower that that in group A（4.81±1.03） versus（6.77±1.14）,（P〈0.05）;the mechanical ventilation of group B , 5h airwayPpk、Pplat、PEEPi level, [（4.50±0.72）、（3.60±0.76）、（1.07±0.20）]were signif icantly highter than those in group A[（3.67±0.65）、（3.04±0.57）、（0.80±0.15）]（P〈0.05）;the the mechanical ventilation of group B , 24h airwayPpk、Pplat、PEEPi level,[（4.27±0.54）、（3.58±0.67）、（0.95±0.11）]were significantly higher than those in [（3.62±0.76）、（2.92±0.72）、（0.72±0.22）]（P〈0.05）. The pressure injury of group A （0%）was much lower that in group B（18.2%）（P〈0.05）, the mechanical ventilation duration and average hospital stay of group A （7.5±3.4）,（12.7±4.2） were significantly shorter than those in group B （12.2±5.1）,（17.3±6.5）,P〈0.05;while there was no significant difference the survival rate between the two groups（84.1%vs77.3%）（P〉0.05）.Conclusions Small tidal volume of mechanical ventilation for the treatment of COPD combining typeⅡrespiratory failure in eld patients can sinigicantly reduce the lung injury and is a protetive mechanical ventilation which is clinically applicable.
出处
《浙江临床医学》
2014年第11期1731-1733,1747,共4页
Zhejiang Clinical Medical Journal
