本文選題：肺疾病 + 慢性阻塞性　； 參考：《中國(guó)全科醫(yī)學(xué)》2017年09期

【摘要】：目的觀察綜合治療對(duì)老年慢性阻塞性肺疾病(COPD)所致急性呼吸衰竭患者的臨床療效。方法選取2011年7月—2013年8月北京市門(mén)頭溝區(qū)醫(yī)院收治的90例老年COPD所致急性呼吸衰竭患者。按照隨機(jī)數(shù)字表法將患者分為3組,即無(wú)創(chuàng)組、序貫組、綜合治療組,各30例。3組患者在常規(guī)治療的基礎(chǔ)上分別給予無(wú)創(chuàng)通氣治療、有創(chuàng)-無(wú)創(chuàng)序貫通氣治療和綜合治療。檢測(cè)3組患者治療前和治療后4 h、2 d、12 d的急性生理與慢性健康評(píng)分Ⅱ(APACHEⅡ)評(píng)分、克里斯(CRIS)評(píng)分、呼吸頻率(RR)、心率(HR)、平均動(dòng)脈壓(MAP)、動(dòng)脈血?dú)夥治觥矂?dòng)脈血氧分壓(PaO_2)、動(dòng)脈血二氧化碳分壓(PaCO_2)〕、白細(xì)胞計(jì)數(shù)(WBC)。治療后記錄3組患者肺部感染控制(PIC)窗出現(xiàn)時(shí)間、有創(chuàng)通氣時(shí)間、總機(jī)械通氣時(shí)間、ICU住院時(shí)間、總住院時(shí)間、呼吸機(jī)相關(guān)肺炎(VAP)發(fā)生率及住院病死率。檢測(cè)患者入院時(shí)及治療后30 d日間自主呼吸狀態(tài)下第1秒末用力呼氣容積(FEV_1)、最大呼氣容積(FVC),比較患者肺通氣功能〔FEV_1占預(yù)計(jì)值百分比(FEV_1%)、FEV_1/FVC〕。結(jié)果序貫組、綜合治療組治療后2 d和治療后12 d RR、HR、PaCO_2、WBC低于無(wú)創(chuàng)組,序貫組、綜合治療組治療后2 d PaO_2高于無(wú)創(chuàng)組,綜合治療組治療后12 d PaO_2高于無(wú)創(chuàng)組(P0.05);綜合治療組治療后2 d和治療后12 d RR、PaCO_2、WBC低于序貫組,PaO_2高于序貫組,綜合治療組治療后2 d HR低于序貫組(P0.05)。3組治療后2 d和治療后12 d APACHEⅡ評(píng)分、CRIS評(píng)分、RR、HR、PaCO_2、WBC分別低于本組治療前,PaO_2分別高于本組治療前,序貫組、綜合治療組治療后4 h WBC分別低于本組治療前(P0.05);3組治療后2 d和治療后12 d APACHEⅡ評(píng)分、CRIS評(píng)分、PaCO_2分別低于本組治療后4 h,PaO_2分別高于本組治療后4 h,3組治療后12 d RR、HR、WBC分別低于本組治療后4 h,序貫組、綜合治療組治療后2 d HR、WBC分別低于本組治療后4 h(P0.05);3組治療后12 d APACHEⅡ評(píng)分、CRIS評(píng)分、RR、HR、PaCO_2、WBC分別低于本組治療后2 d,PaO_2分別高于本組治療后2 d(P0.05)。序貫組有創(chuàng)通氣時(shí)間、VAP發(fā)生率大于無(wú)創(chuàng)組,總機(jī)械通氣時(shí)間、ICU住院時(shí)間、總住院時(shí)間小于無(wú)創(chuàng)組(P0.05);綜合治療組有創(chuàng)通氣時(shí)間、VAP發(fā)生率大于無(wú)創(chuàng)組,總機(jī)械通氣時(shí)間、ICU住院時(shí)間、總住院時(shí)間小于無(wú)創(chuàng)組(P0.05);綜合治療組有創(chuàng)通氣時(shí)間、總機(jī)械通氣時(shí)間、ICU住院時(shí)間、總住院時(shí)間、VAP發(fā)生率小于序貫組(P0.05)。序貫組、綜合治療組治療后30 d FEV_1%、FEV_1/FVC大于無(wú)創(chuàng)組(P0.05);綜合治療組治療后30 d FEV_1%、FEV_1/FVC大于序貫組(P0.05)。3組治療后30 d FEV_1%、FEV_1/FVC均大于本組入院時(shí)(P0.05)。結(jié)論綜合治療對(duì)老年COPD所致急性呼吸衰竭患者的臨床療效優(yōu)于無(wú)創(chuàng)通氣治療、有創(chuàng)-無(wú)創(chuàng)序貫通氣治療方式,其有助于改善患者肺功能,縮短機(jī)械通氣時(shí)間、住院時(shí)間,進(jìn)而降低患者的病死率。
[Abstract]:Objective to observe the clinical effect of comprehensive therapy on elderly patients with acute respiratory failure caused by chronic obstructive pulmonary disease (cad). Methods from July 2011 to August 2013, 90 elderly patients with acute respiratory failure caused by COPD were treated in Beijing Mentougou District Hospital. The patients were divided into three groups according to random number table: noninvasive group, sequential group, comprehensive treatment group, 30 patients in each group were treated with noninvasive ventilation on the basis of routine treatment, invasive and noninvasive sequential ventilation therapy and comprehensive treatment. Acute physiological and chronic health score 鈪，

本文編號(hào)：2027098