头罩式无创正压通气对慢性阻塞性肺疾病患者的临床疗效

头罩式无创正压通气对慢性阻塞性肺疾病患者的临床疗效

马芳丽,张志刚,李斌,岳伟岗,侯宇颖,张彩云

兰州大学第一医院重症医学科,兰州大学第一医院重症医学科,兰州大学第一医院重症医学科,兰州大学第一医院重症医学科,兰州大学第一医院护理部,兰州大学第一医院护理部

收稿日期:2019-01-16 修回日期:2019-01-16 出版日期:2019-01-25
基金资助:
甘肃省卫生行业科研项目（项目编号：GSWSKY-2015-86；项目名称：无创正压通气头罩的设计及其在危重病患者中的临床应用研究）

Clinical Effect of Noninvasive Positive Pressure Ventilation for Chronic Obstructive Pulmonary Disease

MA Fangli,ZHANG Zhigang,LI Bin,YUE Weigang,HOU Yuying and ZHANG Caiyun

Department of Intensive Care Unit,the First Hospital of Lanzhou University,Gansu Lanzhou,Department of Intensive Care Unit,the First Hospital of Lanzhou University,Gansu Lanzhou,Department of Intensive Care Unit,the First Hospital of Lanzhou University,Gansu Lanzhou,Department of Intensive Care Unit,the First Hospital of Lanzhou University,Gansu Lanzhou,Department of Nursing,the First Hospital of Lanzhou University,Gansu Lanzhou,Department of Nursing,the First Hospital of Lanzhou University,Gansu Lanzhou

Received:2019-01-16 Revised:2019-01-16 Online:2019-01-25

摘要/Abstract

摘要： 目的：探索头罩式无创正压通气（NIPPV）对慢性阻塞性肺疾病（COPD）患者的临床疗效。方法：选取2017年2月至2018年8月我院重症医学科62例COPD患者作为研究对象，采用随机数字表法随机分为NIPPV头罩组(n=32）和NIPPV鼻面罩组（n=30）。比较两组患者治疗前、治疗后2 h的二氧化碳分压（PaCO2）、氧合指数（PaO2/FiO2）、呼吸频率（RR）、心率（HR）、pH以及动脉收缩压（SAP）的变化情况；同时比较两组患者的漏气发生率、NIPPV治疗时间、初始24 h治疗中断例数、住院死亡例数发生情况。结果：应用头罩式NIPPV治疗后，COPD患者PaCO2水平降低，PaO2/FiO2指数提高，通气治疗2 h后，其HR、RR、SAP更容易下降至正常范围内，患者的病情得以缓解；两组患者住院病死率差异无统计学意义；而NIPPV头罩组患者治疗时间、初始24 h治疗中断率、漏气发生率均降低，差异均有统计学意义。结论：头罩式NIPPV治疗COPD患者具有较好的疗效和耐受性。

Abstract: Objective：To explore the clinical efficacy of noninvasive positive pressure ventilation（NIPPV）with headgear on chronic obstructive pulmonary disease（COPD）. Methods：From February 2017 to August 2018， 62 patients with COPD who were admitted to the department of critical care medicine in our hospital were selected as subjects, and they were randomly divided into the NIPPV hood group(n=32) and NIPPV nasal mask group(n=30).The changes of carbon dioxide partial pressure (PaCO2)， oxygenation index（PaO2/FiO2），respiratory rate（RR），heart rate（HR）， pH and systolic arterial pressure （SAP）were compared between the two groups before treatment and 2 h after treatment.At the same time，the incidence of air leak，the time of NIPPV treatment， the number of initial 24 h treatment interruptions， and the number of hospital deaths were compared between the two groups. Results：After the treatment of applying hood NIPPV， the PaCO2 levels in patients with COPD was effectively reduced, and PaO2/FiO2 was improved. After 2 h of treatment with NIPPV， HR， RR， and SAP were more likely to fall to the normal range， and the patient′s condition was relieved. There was no difference in hospitalized mortality rate of patients in the two groups. NIPPV apply time， initial 24 h treatment interruption， the number of air leaks were lower than those of nasal mask ventilation， the differences were statistically significant. Conclusion：Hood NIPPV has good curative effect and tolerability in the treatment of COPD patients. It is worthy of clinical promotion.

马芳丽,张志刚,李斌,岳伟岗,侯宇颖,张彩云. 头罩式无创正压通气对慢性阻塞性肺疾病患者的临床疗效[J]. .

MA Fangli,ZHANG Zhigang,LI Bin,YUE Weigang,HOU Yuying and ZHANG Caiyun. Clinical Effect of Noninvasive Positive Pressure Ventilation for Chronic Obstructive Pulmonary Disease[J]. .

参考文献

[1]Meduri GU,Conoscenti CC,Menashe P,et al.Non invasive facemask ventilation in patients with acute respiratory failure[J].Chest,1989,95(9):865-870.
[2]International Consensus Conferences in Intensive Care Medicine:Noninvasive positive pressure ventilation in acute respiratory failure[J].Am J Respir Crit Care Med,2001,163:283-291.
[3]张文梅.头罩式无创正压通气在慢性阻塞性肺疾病急性加重期患者中的临床应用[J].国际呼吸杂志,2008,28(15):900-903.
[4]Antonaglia V,Lucangelo U,Zin W A,et al.Intrapulmonary percussive ventilation improves the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease using a helmet[J].Critical care medicine,2006,34(12):2940-2945.
[5]Nava S, Hill N. Non-invasive ventilation in acute respiratory failure[J]. Lancet, 2009, 374: 250-259.
[6]郭华,张容,谢明金.头罩无创正压通气治疗慢性阻塞性肺疾病急性加重期临床疗效分析[J].西部医学,2013,25(5):772-774.
[7]Vital FM,Ladeira MT,Atallah AN.Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema[J].Cochrane Database Syst Rev,2013,(5):CD005351.
[8]Guideline B T S. Non-invasive ventilation in acute respiratory failure[J]. Thorax, 2002, 57(3): 192-211.
[9]李燕.探讨头罩无创正压通气治疗慢性阻塞性肺疾病急性加重期患者的临床康复疗效[J].中国伤残医学,2016(11):138-139.
[10]Tonnelier J M, Prat G, Nowak E,et al. Noninvasive continuous positive airway pressure ventilation using a new helmet interface: a case-control prospective pilot study[J]. Intens Care Med, 2003, 29(11): 2077-2080.
[11]Monica R,Donateella D,Andrea M,et al.Noninvasive ventilation by helmet or face mask in immunocompromised patients:a case-control study[J].CHEST Journal,2004,126(5):1508-1515.
[12]Bhakti K,Patel,et al.Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome:a randomized clinical trial[J].JAMA,2016, 315(22):2435-2441.
[13]Rocco M, Dell’Utri D, Morelli A, et al. Noninvasive ventilation by helmet or face mask in immunocompromised patients: a case-control study[J]. CHEST Journal, 2004, 126(5): 1508-1515.
[14]Conti G, Cavaliere F, Costa R, et al. Noninvasive positive-pressure ventilation with different interfaces in patients with respiratory failure after abdominal surgery: a matched-control study[J]. Resp Care, 2007, 52(11): 1463-1471.
[15]Brambilla A M, Aliberti S, Prina E, et al. Helmet CPAP vs oxygen therapy in severe hypoxemic respiratory failure due to pneumonia[J]. Intens Care Med, 2014, 40(7): 942-949.
[16]Pisani L, Mega C, Vaschetto R, et al. Oronasal mask versus helmet in acute hypercapnic respiratory failure[J]. Eur Respir J, 2014: ERJ-00538-2014.
[17]Patel B K, Wolfe K S, Pohlman A S, et al. Effect of Noninvasive Ventilation Delivered by Helmet vs Face Mask on the Rate of Endotracheal Intubation in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial[J]. JAMA, 2016, 315(22):2435-2441.
[18]Antonelli M, Pennisi M A, Pelosi P, et al. Noninvasive Positive Pressure Ventilation Using a Helmet in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Feasibility Study[J]. The Journal of the American Society of Anesthesiologists, 2004, 100(1): 16-24.
[19]Antonaglia V, Ferluga M, Molino R, et al. Comparison of noninvasive ventilation by sequential use of mask and helmet versus mask in acute exacerbation of chronic obstructive pulmonary disease: a preliminary study[J]. Respiration, 2011, 82(2): 148-154.
[20]Antonaglia V, Lucangelo U, Zin W A, et al. Intrapulmonary percussive ventilation improves the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease using a helmet[J]. Critical care medicine, 2006, 34(12): 2940-2945.

快速检索引用检索图表检索高级检索