摘要
目的通过分析76例慢性阻塞性肺疾病(简称慢阻肺)合并Ⅱ型呼吸衰竭患者有创呼吸机通气治疗中血气指标控制对预后的影响,探讨缩短有创机械通气时间及改善预后的方案。方法纳入2011年12月至2014年11月期间收治的76例接受有创机械通气治疗的慢阻肺合并Ⅱ型呼吸衰竭患者。按血气中p H、Pa O2、Pa CO2等指标的控制程度不同将患者分为常规参数治疗组(A组)及低参数治疗组(B组)。A组为控制p H 7.40±0.05、Pa O2(70±5)mm Hg、Pa CO2(55±5)mm Hg范围内,B组为控制p H 7.35±0.05、Pa O2(60±5)mm Hg、Pa CO2(60±5)mm Hg范围内。观察两组所需呼吸机参数、撤离呼吸机时间、无创序贯机械通气率、呼吸机相关性肺炎发生率及二次插管率等的差异。结果 B组所需吸入氧浓度[(29.5±1.5)%比(35.5±4.1)%]、潮气量[(5.9±0.9)m L/kg比(6.9±1.5)m L/kg]、压力支持[(12.2±1.9)cm H2O比(13.5±2.6)cm H2O]等呼吸机参数均显著低于A组(P<0.05)。B组所需机械通气时间显著低于A组[(128±32)h比(180±54)h,P<0.05]。撤离呼吸机后无创序贯机械通气率(20.7%比48.9%)、呼吸机相关肺炎发生率(6.9%比21.3%)以及二次插管率(3.4%比14.9%)亦较低,差异均有统计学意义(P<0.05)。结论在慢阻肺呼吸衰竭患者的有创机械通气过程中,给予低吸入氧浓度、小潮气量、低压力支持,使患者血气指标控制在一个相对较低的氧分压并允许一定程度的二氧化碳潴留,可减少有创机械通气的时间,降低呼吸机相关并发症的发生,改善预后。
Objective To investigate the effects of arterial blood gas index control during invasive mechanical ventilation on prognosis in COPD patients with type Ⅱ respiratory failure. Methods Seventy-six COPD patients with hypercapnic respiratory failure who underwent invasive mechanical ventilation were recruited in the study. The patients were divided into group A with conventional arterial blood gas index control [p H of 7. 40 ± 0. 05,Pa O2of( 70 ± 5) mm Hg,Pa CO2of( 55 ± 5) mm Hg],and group B with low index control [p H of 7. 35 ± 0. 05,Pa O2of( 60 ± 5) mm Hg,Pa CO2of( 60 ± 5) mm Hg].Two groups were compared on the required parameters of invasive mechanical ventilation,the duration of invasive mechanical ventilation,the incidence rate of sequential therapy in noninvasive mechanical ventilation,ventilator associated pneumonia and secondary intubation,etc. Results The required parameters of invasive mechanical ventilation in group B including tidal volume( VT) and pressure support( PS),the duration of invasive mechanical ventilation,the incidence rate of sequential therapy in noninvasive mechanical ventilation,ventilator associated pneumonia and secondary intubation were all significantly lower than those in group A( P < 0. 05). Conclusion The strategy to permit a lower Pa O2 and carbon dioxide retention to a certain extent at lower Fi O2,VTand PS levels in invasive mechanical ventilation can reduce the duration of invasive mechanical ventilation and the occurrence of ventilator associated complications,and improve the prognosis in COPD patients with type Ⅱ respiratory failure.
出处
《中国呼吸与危重监护杂志》
CAS
北大核心
2015年第2期132-134,共3页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
慢性阻塞性肺疾病
Ⅱ型呼吸衰竭
有创机械通气
血气分析
预后
Chronic obstructive pulmonary disease
Type Ⅱ respiratory failure
Invasive mechanical ventilation
Arterial blood gas analysis
Prognosis
