本文關(guān)鍵詞：家庭無(wú)創(chuàng)通氣對(duì)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(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 慢性阻塞性肺疾病 呼吸衰竭 無(wú)創(chuàng)正壓通氣 長(zhǎng)期家庭氧療

【摘要】：目的:探討家庭無(wú)創(chuàng)通氣對(duì)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(yù)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(nèi)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?dú)夥治鎏崾緸棰蛐秃粑ソ?應(yīng)用隨機(jī)數(shù)表隨機(jī)抽取患者40例作為無(wú)創(chuàng)組,出院后繼續(xù)給予無(wú)創(chuàng)呼吸機(jī)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(gè)月(出院時(shí))、3個(gè)月、6個(gè)月后血?dú)夥治�、肺功能、BODE指數(shù)、6分鐘步行試驗(yàn)(6 min of walking distance,6MWD)、CAT評(píng)分、m MRC評(píng)分及住院次數(shù)情況。結(jié)果:無(wú)創(chuàng)組與氧療組兩組患者出院時(shí)基本情況、Pa CO2、Pa O2、肺功能、BODE指數(shù)、6MWD、CAT評(píng)分、m MRC評(píng)分,兩組比較無(wú)顯著性差異(P0.05),出院后3個(gè)月、6個(gè)月Pa CO2、Pa O2、肺功能、BODE指數(shù)、6MWD、CAT評(píng)分、m MRC評(píng)分及6個(gè)月內(nèi)住院次數(shù)比較結(jié)果如下:1無(wú)創(chuàng)組患者出院3個(gè)月時(shí)Pa CO260.04±5.33mm Hg較出院時(shí)Pa CO265.85±4.80mm Hg顯著改善(P=0.000),Pa O283.93±27.31mm Hg較出院時(shí)Pa O275.95±12.76mm Hg無(wú)明顯改變(P=0.098);無(wú)創(chuàng)組患者出院6個(gè)月時(shí)Pa CO255.33±6.30mm Hg較出院3個(gè)月時(shí)進(jìn)一步改善(P=0.000),較出院時(shí)明顯改善(P=0.000)。Pa O289.41±15.83mm Hg較出院3個(gè)月時(shí)有所改善(P=0.048),較出院時(shí)明顯改善(P=0.003)。氧療組患者出院3個(gè)月時(shí)Pa CO265.85±5.31mm Hg較出院時(shí)Pa CO268.13±5.10mm Hg略改善(P=0.054),Pa O275.16±9.39mm Hg較出院時(shí)Pa O271.15±10.82mm Hg有所改善(P=0.011);氧療組患者出院6個(gè)月時(shí)Pa CO266.15±5.50mm Hg較出院3個(gè)月時(shí)無(wú)明顯改善(P=0.783),Pa O276.15±10.82mm Hg較出院3個(gè)月時(shí)無(wú)明顯改善(P=0.563);Pa CO2較出院時(shí)略改善(P=0.105),Pa O2較出院時(shí)顯著改善(P=0.008);出院3個(gè)月時(shí)無(wú)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(gè)月時(shí)無(wú)創(chuàng)組Pa CO2、Pa O2較氧療組改善更明顯(P均為0.000)。2無(wú)創(chuàng)組患者出院3個(gè)月時(shí)肺功能示FEV1為48.66±11.35L較出院時(shí)FEV1為44.9±10.31L無(wú)改善(P=0.125),FVC64.75±7.89L較出院時(shí)FVC64.54±7.67L無(wú)改善(P=0.903),FEV1/FVC59.03±8.80%較出院時(shí)FEV1/FVC58.80±8.44%無(wú)改善(P=0.905);無(wú)創(chuàng)組患者出院6個(gè)月時(shí)肺功能示FEV1為51.18±11.45L較出院3個(gè)月時(shí)無(wú)改善(P=0.327),較出院時(shí)有所改善(P=0.012),FVC65.15±8.26L較出院3個(gè)月時(shí)、出院時(shí)均無(wú)改善(P分別為0.830,0.734),FEV1/FVC59.15±9.10%較出院3個(gè)月時(shí)、出院時(shí)均無(wú)改善(P分別為0.953,0.858)。氧療組患者出院3個(gè)月時(shí)肺功能示FEV1為39.57±9.45L較出院時(shí)FEV1為40.61±9.55L無(wú)改善(P=0.626),FVC60.80±9.42L較出院時(shí)FVC61.64±9.09L無(wú)改善(P=0.685),FEV1/FVC50.32±9.70%較出院時(shí)FEV1/FVC51.79±9.78無(wú)改善(P=0.658);氧療組患者出院6個(gè)月時(shí)肺功能示FEV1為38.27±9.51L較出院3個(gè)月時(shí)、出院時(shí)均無(wú)改善(P分別為0.543,0.277),FVC59.69±9.77L較出院3個(gè)月時(shí)、出院時(shí)均無(wú)改善(P分別為0.609,0.359),FEV1/FVC49.47±9.57%較出院3個(gè)月時(shí)、出院時(shí)無(wú)改善(P分別為0.691,0.401)。無(wú)創(chuàng)組患者出院3個(gè)月時(shí)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(gè)月時(shí)無(wú)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(wú)創(chuàng)組患者出院3個(gè)月時(shí)BODE指數(shù)3.83±2.32分較出院時(shí)4.63±2.24分無(wú)改善(P=0.121),6分鐘步行試驗(yàn)275.12±110.07M較出院時(shí)263.48±110.07M無(wú)改善(P=0.638);無(wú)創(chuàng)組患者出院6個(gè)月時(shí)BODE指數(shù)3.40±2.36分較出院3個(gè)月時(shí)無(wú)改善(P=0.419),較出院時(shí)有改善(P=0.022),6分鐘步行試驗(yàn)284.74±104.86M較出院3個(gè)月時(shí)、出院時(shí)均無(wú)改善(P分別為0.690,0.379)。氧療組患者出院3個(gè)月時(shí)BODE指數(shù)5.03±2.38分較出院時(shí)5.28±2.22分無(wú)改善(P=0.628),6分鐘步行試驗(yàn)226.99±106.20M較出院時(shí)226.92±106.33M無(wú)改善(P=0.998);氧療組患者出院6個(gè)月時(shí)BODE指數(shù)4.98±2.476分較出院3個(gè)月時(shí)、出院時(shí)均無(wú)改善(P分別為0.927,0.569),6分鐘步行試驗(yàn)229.01±109.57M較出院3個(gè)月時(shí)、出院時(shí)均無(wú)改善(P分別為0.934,0.931)。無(wú)創(chuàng)組患者出院3個(gè)月時(shí)BODE指數(shù)較氧療組有改善(P=0.025),無(wú)創(chuàng)組6鐘步行試驗(yàn)較氧療組無(wú)改善(P=0.050),出院6個(gè)月時(shí)無(wú)創(chuàng)組BODE指數(shù)、6鐘步行試驗(yàn)較氧療組均明顯改善(P分別為0.005,0.023)。4無(wú)創(chuàng)組患者出院3個(gè)月時(shí)CAT評(píng)分19.25±5.84分較出院時(shí)CAT評(píng)分22.08±6.38分有改善(P=0.042),m MRC評(píng)分1.98±0.95分較出院時(shí)m MRC評(píng)分2.80±0.63分有改善(P=0.001);無(wú)創(chuàng)組患者出院6個(gè)月時(shí)CAT評(píng)分15.58±5.80分較出院3個(gè)月時(shí)有進(jìn)一步改善(P=0.006),m MRC評(píng)分1.33±1.12分較出院3個(gè)月時(shí)有更加明顯改善(P=0.006)。氧療組患者出院3個(gè)月時(shí)CAT評(píng)分19.98±6.33分較出院時(shí)CAT評(píng)分21.53±5.51分無(wú)改善(P=0.246),m MRC評(píng)分2.08±0.83分較出院時(shí)m MRC評(píng)分2.33±0.62分無(wú)改善(P=0.130);氧療組患者出院6個(gè)月時(shí)CAT評(píng)分19.53±7.74分較出院3個(gè)月時(shí)、出院時(shí)均無(wú)改善(P分別為0.777,0.187),m MRC評(píng)分1.75±1.08分較3個(gè)月時(shí)無(wú)改善(P=0.135),較出院時(shí)有所改善(P=0.005)。無(wú)創(chuàng)組患者出院3個(gè)月時(shí)CAT評(píng)分、m MRC評(píng)分較氧療組均無(wú)差異(P分別為0.596,0.617),出院6個(gè)月時(shí)無(wú)創(chuàng)組CAT評(píng)分較氧療組有所改善(P=0.012),m MRC評(píng)分較氧療組無(wú)改善(P=0.088)。5無(wú)創(chuàng)組患者出院6個(gè)月內(nèi)住院次數(shù)較氧療組患者住院次數(shù)明顯減少(P=0.019)。結(jié)論:1長(zhǎng)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(píng)分,對(duì)Pa CO2、肺功能、BODE指數(shù)、6分鐘步行距離、CAT評(píng)分無(wú)明顯改善。2 COPD穩(wěn)定期合并II型呼吸衰竭的患者應(yīng)用家庭無(wú)創(chuàng)正壓通氣可以有效改善Pa O2、Pa CO2、FEV1、BODE、CAT評(píng)分、m MRC評(píng)分,減少患者住院次數(shù),但不能有效改善患者6分鐘步行距離。3與長(zhǎng)期家庭氧療相比家庭無(wú)創(chuàng)正壓通氣更能有效改善Pa CO2、肺功能、BODE、CAT評(píng)分、m MRC評(píng)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?qiáng)浣忛櫌娆℃暟鎯呭啠?

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