无创机械通气联合雾化吸入药物治疗AECOPD并发呼吸衰竭的临床观察

摘要

OBJECTIVE:To observe the clinical efficacy and safety of noninvasive mechanical ventilation combined with aero-sol inhalation drug in the treatment of AECOPD complicating with respiratory failure. METHODS:90 patients diagnosed as AECO-PD complicating with respiratory failure were selected and randomly divided into observation group and control group,with 45 cas-es in each group. Both groups received routine treatment as oxygen supply at low flow rate,anti-infection,relieving asthma,venti-lation,cardiotonic,spasmolysis and nutritional support. Control group received noninvasive mechanical ventilation;observation group was additionally given aerosol inhalation of Budesonide atomized liquid+terbutaline+ipratropium bromide,bid. Both groups received 7 d of treatment. Clinical efficacy of 2 groups were compared as well as pH value,PaCO2,PaO2,HR,RR and PEF lev-els before and after treatment. The occurrence of ADR was observed. RESULTS:Total effective rate of observation group was 93.3%,which was significantly higher than 73.3% of control group,with statistical significance(P<0.05). There was no statisti-cal significance in blood gas analysis indexes,HR,RR and REF between 2 groups before treatment (P>0.05). pH value,PaO2 and PEF of 2 groups increased after treatment,while PaO2,HR and RR decreased;the observation group was better than the con-trol group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Noninvasive me-chanical ventilation combined with aerosol inhalation drug is effective in the treatment of AECOPD complicating with respiratory failure,and can effectively improve blood gas indexes,HR,RR and PEF with good safety.%目的：观察无创机械通气联合雾化吸入药物治疗慢性阻塞性肺疾病急性加重期（AECOPD）并发呼吸衰竭的临床疗效及安全性。方法：选取经确诊的AECOPD并发呼吸衰竭患者90例，按随机数字表法分为观察组和对照组，各45例。两组患者均给予低流量的供氧、抗感染、平喘、通气、强心、解痉及营养支持等常规治疗。对照组患者进行无创机械通气治疗；观察组患者在对照组基础上给予吸入用布地奈德2 ml混悬+硫酸特布他林雾化液2 ml+异丙托溴铵气雾剂1 ml雾化吸入治疗，bid。两组患者均连续治疗7 d。比较两组患者临床疗效及治疗前后的动脉血气指标[pH值、二氧化碳分压（PaCO2）、氧分压（PaO2）]及心率（HR）、呼吸频率（RR）、峰值呼气流速（PEF）水平，并观察不良反应。结果：观察组患者临床总有效率为93.3％，显著高于对照组的73.3％，差异有统计学意义（P＜0.05）。治疗前，两组患者动脉血气指标及HR、RR、PEF比较，差异均无统计学意义（P＞0.05）；治疗后，两组患者pH值、PaO2、PEF显著升高，PaCO2、HR、RR显著降低，且观察组优于对照组，差异均有统计学意义（P＜0.05）。两组患者均未见明显不良反应发生。结论：无创机械通气联合雾化吸入药物治疗AECOPD并发呼吸衰竭疗效显著，能明显改善患者血气指标及HR、RR、PEF，且安全性较好。