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目的:探讨慢性阻塞性肺病急性加重期(AECOPD)患者无创正压通气(NPPV)不同压力支持水平对腹内压力的影响。方法:收集我院收治的AECOPD患者150例,随机分为A、B、C三组,每组各50例。给予所有患者无创机械通气,A、B、C组患者分别给予吸气相正压(IPAP)值为12 cm H2O、16 cm H2O、20 cm H2O,其他参数一致,通气治疗结束后,对所有患者的腹内压、不良反应发生率、呼吸困难程度以及动脉血气水平进行检测并比较。结果:通气后,A、B、C三组患者腹内压水平与通气前相比升高(P<0.05);与A、B组患者相比,C组患者腹内压水平较高(P<0.05);通气后,A、C两组患者的不良反应发生率与B组相比较高(P<0.05);通气后,B组患者呼吸困难评分与A、C组相比较高(P<0.05)。治疗后,三组患者的Pa O2与通气前相比升高,Pa CO2降低(P<0.05),与A、C组相比,B组患者的Pa O2水平较高,Pa CO2较低(P<0.05)。结论:AECOPD患者通气后腹内压水平随NPPV压力的升高而升高;中等压力的无创正压通气能够改善AECOPD患者的呼吸困难以及动脉血气水平,降低不良反应发生率。
Objective: To investigate the effect of different pressure support levels of non-invasive positive pressure ventilation (NPPV) on intra-abdominal pressure in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: AECOPD patients were collected in our hospital 150 cases were randomly divided into A, B, C three groups, each group of 50 cases. All patients were given noninvasive mechanical ventilation. Patients in groups A, B and C were given IPAP values of 12 cm H2O, 16 cm H2O, and 20 cm H2O, respectively. All other parameters were consistent. After ventilation, all patients Intra-abdominal pressure, the incidence of adverse reactions, degree of dyspnea and arterial blood gas levels were detected and compared. Results: After ventilation, the levels of intra-abdominal pressure in A, B and C groups were significantly higher than those before ventilation (P <0.05). Compared with those in A and B groups, the intra-abdominal pressure was significantly higher in group C <0.05). After ventilated, the incidence of adverse reactions in patients A and C was higher than that in patients in group B (P <0.05). After ventilation, the scores of dyspnea in patients in group B were higher than those in patients in groups A and C (P < 0.05). After treatment, the PaO 2 in the three groups increased compared with that before ventilation and the PaCO 2 decreased (P <0.05). Compared with groups A and C, PaO 2 in group B was higher and PaCO 2 was lower (P <0.05). CONCLUSION: The intra-abdominal pressure of AECOPD patients increases with the increase of NPPV pressure. The moderate pressure non-invasive positive pressure ventilation can improve the dyspnea and arterial blood gas level of AECOPD patients and reduce the incidence of adverse reactions.