本文關鍵詞：家庭無創(chuàng)通氣對慢性阻塞性肺疾病并發(fā)Ⅱ型呼吸衰竭穩(wěn)定期患者療效分析　出處：《河北醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 慢性阻塞性肺疾病 呼吸衰竭 無創(chuàng)正壓通氣 長期家庭氧療

【摘要】：目的:探討家庭無創(chuàng)通氣對慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)并發(fā)Ⅱ型呼吸衰竭穩(wěn)定期患者的治療效果以及預后的影響。方法:收集2014年12月~2016年1月在保定市第二中心醫(yī)院呼吸內科接受治療的慢性阻塞性肺疾病急性加重期并發(fā)II型呼吸衰竭的患者80例,病情平穩(wěn)后完善肺功能檢查提示肺功能為重度、極重度,血氣分析提示為Ⅱ型呼吸衰竭,應用隨機數表隨機抽取患者40例作為無創(chuàng)組,出院后繼續(xù)給予無創(chuàng)呼吸機治療,另外40例為氧療組,出院后給予持續(xù)低流量吸氧治療。觀察兩組患者在出院后0個月(出院時)、3個月、6個月后血氣分析、肺功能、BODE指數、6分鐘步行試驗(6 min of walking distance,6MWD)、CAT評分、m MRC評分及住院次數情況。結果:無創(chuàng)組與氧療組兩組患者出院時基本情況、Pa CO2、Pa O2、肺功能、BODE指數、6MWD、CAT評分、m MRC評分,兩組比較無顯著性差異(P0.05),出院后3個月、6個月Pa CO2、Pa O2、肺功能、BODE指數、6MWD、CAT評分、m MRC評分及6個月內住院次數比較結果如下:1無創(chuàng)組患者出院3個月時Pa CO260.04±5.33mm Hg較出院時Pa CO265.85±4.80mm Hg顯著改善(P=0.000),Pa O283.93±27.31mm Hg較出院時Pa O275.95±12.76mm Hg無明顯改變(P=0.098);無創(chuàng)組患者出院6個月時Pa CO255.33±6.30mm Hg較出院3個月時進一步改善(P=0.000),較出院時明顯改善(P=0.000)。Pa O289.41±15.83mm Hg較出院3個月時有所改善(P=0.048),較出院時明顯改善(P=0.003)。氧療組患者出院3個月時Pa CO265.85±5.31mm Hg較出院時Pa CO268.13±5.10mm Hg略改善(P=0.054),Pa O275.16±9.39mm Hg較出院時Pa O271.15±10.82mm Hg有所改善(P=0.011);氧療組患者出院6個月時Pa CO266.15±5.50mm Hg較出院3個月時無明顯改善(P=0.783),Pa O276.15±10.82mm Hg較出院3個月時無明顯改善(P=0.563);Pa CO2較出院時略改善(P=0.105),Pa O2較出院時顯著改善(P=0.008);出院3個月時無創(chuàng)組Pa CO2較氧療組降低,Pa O2較氧療組升高(P分別為0.000,0.003),出院6個月時無創(chuàng)組Pa CO2、Pa O2較氧療組改善更明顯(P均為0.000)。2無創(chuàng)組患者出院3個月時肺功能示FEV1為48.66±11.35L較出院時FEV1為44.9±10.31L無改善(P=0.125),FVC64.75±7.89L較出院時FVC64.54±7.67L無改善(P=0.903),FEV1/FVC59.03±8.80%較出院時FEV1/FVC58.80±8.44%無改善(P=0.905);無創(chuàng)組患者出院6個月時肺功能示FEV1為51.18±11.45L較出院3個月時無改善(P=0.327),較出院時有所改善(P=0.012),FVC65.15±8.26L較出院3個月時、出院時均無改善(P分別為0.830,0.734),FEV1/FVC59.15±9.10%較出院3個月時、出院時均無改善(P分別為0.953,0.858)。氧療組患者出院3個月時肺功能示FEV1為39.57±9.45L較出院時FEV1為40.61±9.55L無改善(P=0.626),FVC60.80±9.42L較出院時FVC61.64±9.09L無改善(P=0.685),FEV1/FVC50.32±9.70%較出院時FEV1/FVC51.79±9.78無改善(P=0.658);氧療組患者出院6個月時肺功能示FEV1為38.27±9.51L較出院3個月時、出院時均無改善(P分別為0.543,0.277),FVC59.69±9.77L較出院3個月時、出院時均無改善(P分別為0.609,0.359),FEV1/FVC49.47±9.57%較出院3個月時、出院時無改善(P分別為0.691,0.401)。無創(chuàng)組患者出院3個月時肺功能FEV1、FVC、FEV1/FVC較氧療組均升高(P分別為0.000,0.031,0.000),出院6個月時無創(chuàng)組肺功能FEV1、FVC、FEV1/FVC較氧療組改善更明顯(P分別為0.000,0.013,0.000)。3無創(chuàng)組患者出院3個月時BODE指數3.83±2.32分較出院時4.63±2.24分無改善(P=0.121),6分鐘步行試驗275.12±110.07M較出院時263.48±110.07M無改善(P=0.638);無創(chuàng)組患者出院6個月時BODE指數3.40±2.36分較出院3個月時無改善(P=0.419),較出院時有改善(P=0.022),6分鐘步行試驗284.74±104.86M較出院3個月時、出院時均無改善(P分別為0.690,0.379)。氧療組患者出院3個月時BODE指數5.03±2.38分較出院時5.28±2.22分無改善(P=0.628),6分鐘步行試驗226.99±106.20M較出院時226.92±106.33M無改善(P=0.998);氧療組患者出院6個月時BODE指數4.98±2.476分較出院3個月時、出院時均無改善(P分別為0.927,0.569),6分鐘步行試驗229.01±109.57M較出院3個月時、出院時均無改善(P分別為0.934,0.931)。無創(chuàng)組患者出院3個月時BODE指數較氧療組有改善(P=0.025),無創(chuàng)組6鐘步行試驗較氧療組無改善(P=0.050),出院6個月時無創(chuàng)組BODE指數、6鐘步行試驗較氧療組均明顯改善(P分別為0.005,0.023)。4無創(chuàng)組患者出院3個月時CAT評分19.25±5.84分較出院時CAT評分22.08±6.38分有改善(P=0.042),m MRC評分1.98±0.95分較出院時m MRC評分2.80±0.63分有改善(P=0.001);無創(chuàng)組患者出院6個月時CAT評分15.58±5.80分較出院3個月時有進一步改善(P=0.006),m MRC評分1.33±1.12分較出院3個月時有更加明顯改善(P=0.006)。氧療組患者出院3個月時CAT評分19.98±6.33分較出院時CAT評分21.53±5.51分無改善(P=0.246),m MRC評分2.08±0.83分較出院時m MRC評分2.33±0.62分無改善(P=0.130);氧療組患者出院6個月時CAT評分19.53±7.74分較出院3個月時、出院時均無改善(P分別為0.777,0.187),m MRC評分1.75±1.08分較3個月時無改善(P=0.135),較出院時有所改善(P=0.005)。無創(chuàng)組患者出院3個月時CAT評分、m MRC評分較氧療組均無差異(P分別為0.596,0.617),出院6個月時無創(chuàng)組CAT評分較氧療組有所改善(P=0.012),m MRC評分較氧療組無改善(P=0.088)。5無創(chuàng)組患者出院6個月內住院次數較氧療組患者住院次數明顯減少(P=0.019)。結論:1長期家庭氧療可改善COPD穩(wěn)定期合并II型呼吸衰竭的患者Pa O2、m MRC評分,對Pa CO2、肺功能、BODE指數、6分鐘步行距離、CAT評分無明顯改善。2 COPD穩(wěn)定期合并II型呼吸衰竭的患者應用家庭無創(chuàng)正壓通氣可以有效改善Pa O2、Pa CO2、FEV1、BODE、CAT評分、m MRC評分,減少患者住院次數,但不能有效改善患者6分鐘步行距離。3與長期家庭氧療相比家庭無創(chuàng)正壓通氣更能有效改善Pa CO2、肺功能、BODE、CAT評分、m MRC評分,是臨床上治療II型呼吸衰竭患者的有力工具。
[Abstract]:Objective: To investigate the family of noninvasive ventilation in chronic obstructive pulmonary disease (chronic obstructive pulmonary disease, COPD) in patients with type II respiratory failure during the stable phase of treatment and prognosis. Methods: 80 patients were collected from December 2014 ~2016 in January second in the Baoding Central Hospital of respiratory medicine for treatment of acute chronic obstructive pulmonary disease exacerbation of patients with type II respiratory failure, improve pulmonary function in stable condition after examination showed pulmonary function for severe and extremely severe, blood gas analysis suggests that type II respiratory failure, 40 cases of patients were randomly selected using random number table as a noninvasive group, after discharge to give non-invasive ventilator treatment, other 40 cases oxygen therapy group. After discharge given continuous low flow oxygen therapy. Patients in two groups were observed in 0 months after discharge (discharge), 3 months of analysis, lung function, blood gas index BODE after 6 months, the 6 minute walk test (6 min of walking distance,6MWD),CAT璇勫垎,m MRC璇勫垎鍙婁綇闄㈡鏁版儏鍐，

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