陈鸿敏

【关键词】 无创正压通气 慢性阻塞性肺疾病 呼吸衰竭 肺功能

[Abstract] Objective： To analyze the effect of non-invasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease （COPD） complicated with respiratory failure and its influence on the level of pulmonary function. Method： A total of 118 patients with COPD complicated with respiratory failure admitted to our hospital from June 2018 to June 2020 were selected as the research subjects. According to the random number table method， the patients were divided into control group and study group， 59 cases in each group. Patients in the control group were treated with conventional treatment， while patients in the study group were treated with non-invasive positive pressure ventilation on the basis of conventional treatment. Lung function indexes， respiratory rate， heart rate， blood oxygen saturation， serum inflammatory factors were compared between two groups before and after treatment， the clinical efficacy of two groups were compared. Result： Before treatment， the lung function indexes， respiratory rate， heart rate， blood oxygen saturation and serum inflammatory factors between two groups compared， there were no statistically significant differences （P>0.05）. After treatment， FEV1， FVC and FEV1/FVC% levels in both groups were improved compared with those of before treatment， and the study group were better than those in the control group， the differences were statistically significant （P<0.05）. After treatment， the respiratory rate， heart rate and oxygen saturation of two groups were improved compared with those of before treatment， and the study group were better than those of the control group， the differences were statistically significant （P<0.05）. After treatment， the levels of PCT， IL-33， IL-17， sICAM-1 and VEGF in both groups were lower than those of before treatment， and the study group were lower than those in the control group， the differences were statistically significant （P<0.05）. The total effective rate of the study group was 96.61%， which was higher than 84.75% of the control group， the difference was statistically significant （P<0.05）. Conclusion： Non-invasive positive pressure ventilation has a good effect in the treatment of patients with COPD complicated with respiratory failure. It can effectively improve the level of lung function， respiratory rate， heart rate and blood oxygen saturation， regulate serum inflammatory factors， and it is of great significance for improving the prognosis， which is worthy of clinical application.

[Key words] Non-invasive positive pressure ventilation Chronic obstructive pulmonary disease Respiratory failure Pulmonary function

First-author’s address： Dandong First Hospital， Dandong 118000， China

doi：10.3969/j.issn.1674-4985.2021.21.030

慢性阻塞性肺疾病（慢阻肺）是临床上一种呼吸系统常见疾病，其发病率、病死率均较高，主要症状为持续存在的气流受限以及相关的呼吸系统症状，可对患者劳动能力、生活质量以及生命安全产生重大影响[1]。呼吸衰竭（呼衰）是由于肺通气、换气发生障碍，不能进行有效气体交换，产生缺氧，引起生理代谢紊乱的综合征。研究发现，随着慢阻肺疾病的疾病进展，多合并有呼吸衰竭，临床治疗多常规给予解痉平喘、抗感染、吸氧、祛痰等药物和机械通气等[2]。多项研究表明，慢阻肺合并呼衰时给予无创正压机械通气治疗的效果较好，可避免气管插管，有效预防感染，安全性较好[3-5]。为分析无创正压通气在慢阻肺合并呼衰患者治疗中的效果及对肺功能水平的影响，笔者选取慢阻肺合并呼衰患者118例为研究对象，现报道如下。

1 资料与方法

1.1 一般资料 选取2018年6月-2020年6月本院收治的慢阻肺合并呼衰患者118例为研究对象。纳入标准：均经临床检查，符合中华医学会呼吸病学分会的有关慢阻肺、呼吸衰竭的判定标准，即连续2年每年慢性咳嗽咳痰≥3个月，经肺功能检查显示，吸入支气管舒张剂后FEV1/FVC%<70%，血气分析在静息状态下的PaO2<60 mm Hg（1 mm Hg=0.133 kPa），伴或不伴PaCO2>50 mm Hg;年齡<80周岁;临床治疗期间的病历资料完整。排除标准：精神类疾病，如精神分裂症;意识障碍性疾病，如痴呆等;伴有严重的肺结核纤维化、支气管炎、哮喘、恶性肿瘤、肝肾严重疾病或功能障碍;对本研究所用的治疗方法存在禁忌证;伴有严重的心脑血管疾病，如入组前6个月内发生急性心肌梗死、脑卒中等;中途转院治疗。……