發(fā)布時(shí)間：2018-02-10 11:40

  本文關(guān)鍵詞： 霧化吸入 肝素 氧流量 慢性阻塞性肺疾病 呼吸力學(xué)　出處：《石河子大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的通過(guò)監(jiān)測(cè)AECOPD機(jī)械通氣患者氣道峰壓(Ppeak)、平臺(tái)壓(Pplat)、動(dòng)態(tài)順應(yīng)性(Cd)和吸氣阻力(Raw)、血?dú)夥治黾澳δ芩降淖兓�，比較不同氧流量驅(qū)動(dòng)肝素霧化吸入對(duì)AECOPD機(jī)械通氣患者呼吸力學(xué)的影響，觀察對(duì)患者呼吸力學(xué)改善效果，尋找合適的氧流量。為AECOPD患者機(jī)械通氣選擇霧化吸入時(shí)恰當(dāng)?shù)难趿髁刻峁├碚搮⒖家罁?jù)。 方法選取51例AECOPD機(jī)械通氣患者，按照霧化吸入時(shí)不同氧流量將患者隨機(jī)分為三組：5L/min(A組15例)，7L/min (B組17例)，9L/min (C組15例)。分別于霧化吸入前，霧化后30min、1d、3d、7d各個(gè)時(shí)間點(diǎn)監(jiān)測(cè)患者氣道峰壓(Ppeak)、平臺(tái)壓(Pplat)、動(dòng)態(tài)順應(yīng)性(Cd)和吸氣阻力(Raw)、血?dú)夥治黾澳δ芟嚓P(guān)指標(biāo)。采用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)處理，所有計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(x S)表示，，不同氧流量霧化吸入重復(fù)測(cè)量資料比較采用重復(fù)測(cè)量資料方差分析。 結(jié)果AECOPD患者行機(jī)械通氣霧化吸入肝素后，不同氧流量水平下三組患者呼吸力學(xué)比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)，其中B組呼吸力學(xué)與A、C兩組比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)，A組與C組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。同一組不同監(jiān)測(cè)時(shí)間點(diǎn)比較，與霧化前相比，B組霧化后各個(gè)時(shí)間點(diǎn)呼吸力學(xué)參數(shù)變化明顯，差異有統(tǒng)計(jì)學(xué)意義(P0.05)；A組霧化30min后，各個(gè)呼吸力學(xué)指標(biāo)與霧化前相比有統(tǒng)計(jì)學(xué)意義(P0.05)，而C組霧化前后改變不明顯(P0.05)。不同氧流量驅(qū)動(dòng)肝素霧化吸入，三組患者活化部分凝血活酶時(shí)間(APTT)、凝血酶原時(shí)間(PT)、纖維蛋白原(FIB)在霧化前、第7天比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論不同氧流量驅(qū)動(dòng)肝素霧化吸入治療AECOPD機(jī)械通氣患者時(shí)，采用7L/min氧流量驅(qū)動(dòng)肝素霧化吸入治療效果方面優(yōu)于5L/min和9L/min的氧流量�？捎行Ы档突颊邭獾婪鍓�、平臺(tái)壓、吸氣阻力，增加胸肺動(dòng)態(tài)順應(yīng)性，達(dá)到最佳霧化效果。7L/min氧流量驅(qū)動(dòng)肝素霧化吸入治療AECOPD機(jī)械通氣患者，有利于機(jī)械通氣的執(zhí)行和通氣效果的提高，而且方法簡(jiǎn)便易行。對(duì)AECOPD機(jī)械通氣患者采用肝素霧化吸入治療是安全有效的，三組患者在霧化結(jié)束后，未見(jiàn)明確的肝素相關(guān)的副作用，值得臨床推廣應(yīng)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 鹵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.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R473.5

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