振动排痰联合双水平气道正压通气治疗慢性阻塞性肺疾病急性加重期的临床效果观察

摘要

Objective To investigate the clinical effect of vibration sputum discarding combined with bi - level positive airway pressure ventilation(BiPAP)on acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods A total of 228 AECOPD patients were selected in Xinyi Railroad Hospital from September 2010 to August 2014,and they were divided into control group and treatment group according to visiting sequence,each of 114 cases. Patients of both groups were given routine comprehensive treatment and BiPAP(PSV + PEEP),and patients of control group were given extra artificial back knocking sputum discarding,patients of treatment group were given vibration sputum discarding;both groups treated for 7 days. Clinical effect,antibiotics use time,mechanical ventilation time,hospital stays,blood - gas index( including PaCO2 , PaCO2 )before and after treatment,expectoration drainage volume within 2 days after admission,at 3 to 4 days and at 5 to 7 days after admission,total expectoration drainage volume were compared between the two groups. Results No statistically significant differences of clinical effect was found between the two groups(P = 0. 302). No statistically significant differences of pH,PaO2 or PaCO2 was found between the two groups before treatment(P > 0. 05);after treatment,pH and PaO2 of treatment group were statistically significantly higher than those of control group, while PaCO2 of treatment group was statistically significantly lower than that of control group(P < 0. 01). Expectoration drainage volume within 2 days after admission,at 3 to 4 days after admission and total expectoration drainage volume of treatment group were statistically significantly higher than those of control group,while expectoration drainage volume at 5 to 7 days after admission of treatment group was statistically significantly lower than that of control group(P < 0. 01). Antibiotics use time,mechanical ventilation time and hospital stays of treatment group were statistically significantly shorter than those of control group(P < 0. 01). Conclusion Vibration sputum discarding combined with BiPAP can effectively improve the blood - gas tension of AECOPD patients,shorten the mechanical ventilation time and hospital stays,reduce the dosage of antibiotics,is helpful to discard sputum out of the body within a short time,effectively relieve the clinical symptoms and signs.%目的：观察振动排痰联合双水平气道正压通气（ BiPAP）治疗慢性阻塞性肺疾病急性加重期（AECOPD）的临床效果。方法选取2010年9月—2014年8月新沂市铁路医院收治的 AECOPD 患者228例，按就诊顺序1∶1分为治疗组和对照组，每组114例。两组患者均给予常规综合治疗，并同时给予 BiPAP 治疗，模式为压力支持通气（PSV）＋呼气末正压通气（PEEP）；对照组患者在此基础上加用人工叩背法排痰，观察组患者在此基础上加用振动排痰法排痰；两组患者均治疗7 d。比较两组患者临床疗效、抗生素使用时间、机械通气时间及住院时间，治疗前后血气分析指标〔pH 值、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）〕，入院0～2 d、3～4 d、5～7 d排痰量及总排痰量。结果两组患者临床疗效比较，差异无统计学意义（P ＝0.302）。治疗前两组患者 pH 值、PaO2、PaCO2比较，差异无统计学意义（P ＞0.05）；治疗后治疗组患者 pH 值、PaO2均高于对照组，PaCO2低于对照组（P＜0.01）。治疗组患者入院0～2 d、3～4 d 排痰量及总排痰量均高于对照组，入院 5～7 d 排痰量低于对照组（ P ＜0.01）。治疗组患者抗生素使用时间、机械通气时间及住院时间均短于对照组（P ＜0.01）。结论振动排痰联合 BiPAP能有效改善 AECOPD 患者血气水平，缩短机械通气时间及住院时间，并减少抗生素用量，在短时间内将痰液排出体外，从而快速改善患者的症状及体征。