CAJ | 학술논문

目的：评价2种无创通气模式治疗慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）合并呼吸衰竭患者的效果。方法将80例COPD并呼吸衰竭患者随机分为观察组和对照组各40例。观察组以平均容积保证压力支持（ average volume assured pressure support，AVAPS）模式通气治疗，对照组采用自主触发/时间模式（S/T）通气治疗。两组患者在无创通气过程中，均采用护理干预措施以提高患者依从性，减少不良反应。比较两组患者治疗3 d后的动脉血酸碱度（PH）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、血氧饱和度（SaO2）指标。观察比较两组患者上机后达到人机协调所用时间和治疗3 d内发生不良反应（胸闷憋气感、人机对抗、腹胀）和上机失败的情况。结果无创通气治疗3 d后，两组患者 PaCO2下降，PaO2、SaO2上升，PH值改善，差异无统计学意义（P＞0.05）。观察组在达到人机协调的时间较对照组短，胸闷憋气感、人机对抗和腹胀等不良反应发生较对照组低，两组比较差异具有统计学意义（P＜0.01）。结论应用AVAPS模式通气治疗COPD合并呼吸衰竭安全有效，患者依从性较好，值得临床推广。
목적：평개2충무창통기모식치료만성조새성폐질병（chronic obstructive pulmonary disease，COPD）합병호흡쇠갈환자적효과。방법장80례COPD병호흡쇠갈환자수궤분위관찰조화대조조각40례。관찰조이평균용적보증압력지지（ average volume assured pressure support，AVAPS）모식통기치료，대조조채용자주촉발/시간모식（S/T）통기치료。량조환자재무창통기과정중，균채용호리간예조시이제고환자의종성，감소불량반응。비교량조환자치료3 d후적동맥혈산감도（PH）、동맥혈양분압（PaO2）、동맥혈이양화탄분압（PaCO2）、혈양포화도（SaO2）지표。관찰비교량조환자상궤후체도인궤협조소용시간화치료3 d내발생불량반응（흉민별기감、인궤대항、복창）화상궤실패적정황。결과무창통기치료3 d후，량조환자 PaCO2하강，PaO2、SaO2상승，PH치개선，차이무통계학의의（P＞0.05）。관찰조재체도인궤협조적시간교대조조단，흉민별기감、인궤대항화복창등불량반응발생교대조조저，량조비교차이구유통계학의의（P＜0.01）。결론응용AVAPS모식통기치료COPD합병호흡쇠갈안전유효，환자의종성교호，치득림상추엄。
Objective To evaluate the effects of two models of noninvasive ventilation therapy on chronic obstructive pulmonary disease (COPD) patients with respiratory failure. Methods Eighty COPD patients with respiratory failure were randomly divided into observation group and control group, with 40 cases in each group. Patients in observation group were treated by average volume assured pressure support (AVAPS) model of noninvasive ventilation, but those in control group by self trigger/time (S/T) model of noninvasive ventilation. Nursing intervention measures were used to reduce adverse reaction during the ventilation and pH, PaO 2, PaCO2, adverse reaction 3d after the treatment were compared. Results Patients in two groups showed a significant improvement in pH, PaO2, PaCO2 three days after treatment,but there was no statistically significant difference of intergroup comparison (P>0.05). There was shorter time of man-machine coordination in observation group, and lower incidence of chest tightness of breath, man-machine confrontation and abdominal distension, which showed statistical difference (P<0.01). Conclusion AVAPS model is safe and effective for COPD patients with respiratory failure and it is worth to be popularized.