无创正压通气治疗老年慢性阻塞性肺疾病急性加重期并发重症呼衰对患者血气及炎性指标的影响

摘要

目的 探讨无创正压通气(NPPV)治疗老年慢性阻塞性肺疾病急性加重期(AECOPD)并发呼吸衰竭对患者血气指标、血清炎性指标的影响.方法 选取2015年1月至2016年8月96例AECOPD并发重症呼吸衰竭患者进行回顾性分析,其中52例患者采用NPPV结合常规治疗(NPPV组)、对照组44例采用常规治疗联合鼻导管或面罩吸氧,对比两组患者治疗前后的血气指标、血清炎症指标变化.结果 治疗前,两组患者的pH、PaO2、PaCO2、SaO2、HR、RR、IL-13、IL-18、sICAM-1、hs-CRP水平差异无统计学意义(P>0.05);治疗24h、48h,NPPV组的pH、PaO2、SaO2水平高于对照组,差异有统计学意义(P<0.05),PaCO2、RR、IL-13、IL-18、sICAM-1、hs-CRP水平低于对照组,差异有统计学意义(P<0.05);治疗24h、48h,两组患者的H、PaO2、SaO2水平较治疗前显著的提高,差异有统计学意义(P<0.05),PaCO2、RR水平较治疗前显著的降低,差异有统计学意义(P<0.05);治疗后,NPPV组显效73.08%、有效25.00%、无效1.92%,对照组显效50.00%、有效43.18%、无效6.82%,两组比较,差异有统计学意义(P<0.05).结论 NPPV治疗老年AECOPD并发呼吸衰竭能显著的改善患者血气指标及降低炎症反应.%Objective To investigate the effect of noninvasive positive pressure ventilation(NPPV)on arterial blood gas analysis and serum inflammation markers in treating elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated by respiratory failure.Methods 96 patients with AECOPD complicated by severe respiratory failure from January 2015 to August 2016 were retrospectively analyzed.52 of them were received NPPV combined with conventional therapy(NPPV group)while 44 patients were received conventional therapy combined with nasal catheter mask oxygen inhalation(control group).Changes of arterial blood gas analysis and serum inflammation markers of two groups were compared before and after treatment.Results There were no statistical differences in the levels of pH、PaO2、PaCO2、SaO2、HR、RR、IL-13、IL-18、sICAM-1、hs-CRP in two groups(P>0.05).24 and 48 hours after treatment,NPPV group had higher levels of pH、PaO2、SaO2 than control group(P<0.05)and had lower levels of PaCO2、RR、IL-13、IL-18、sICAM-1、hs-CRP than control group(P<0.05).24 and 48 hours after treatment,compared with those before treatment,levels of H、PaO2、SaO2 in both two groups were remarkably improved(P<0.05)and levels of PaCO2、RR remarkably decreased(P<0.05).After treatment,the significant efficiency,effective rate and inefficiency of NPPV group were respectively 73.08%,25.00% and 1.92% while the significant efficiency,effective rate and inefficiency of control group were respectively 50.00%,43.18% and 6.82%.There were statistical difference between two groups(P<0.05).Conclusion NPPV treatment of elderly AECOPD complicated with respiratory failure can significantly improve the arterial blood gas and reduce the inflammatory response.