CAJ | 학술논문

目的：探讨不同氧流量驱动肝素雾化吸入对慢性阻塞性肺疾病急性加重期（ AECOPD）机械通气患者血气及凝血功能的影响。方法将51例AECOPD机械通气患者随机分为A、B、C三组，其中A组（17例）给予5 L／min氧流量雾化吸入；B组（19例）给予7 L／min；C组（15例）给予9 L／min。监测雾化前、雾化后30 min、1 d、3 d、7 d各个时间点血气及雾化前及雾化后第7天的凝血功能参数的变化情况。结果与A组、C组比较，B组患者在各个监测时间点的氧分压（PaO2）、二氧化碳分压（PaCO2）及氧合指数（PaO2／FiO2）改善最为明显（P＜0．05）；A组与C组比较差异无统计学意义（ P＞0．05）。同一组不同监测时间点与雾化前比较，B组雾化后各个时间点的PaO2、PaCO2、PaO2／FiO2观察指标变化明显（P＜0．05）；A组雾化30 min后，各个呼吸力学指标与雾化前比较差异有统计学意义（P＜0．05），而C组雾化前后改变不明显（P＞0．05）。三组活化部分凝血活酶时间（ APTT）、凝血酶原时间（ PT）、纤维蛋白原（ FIB）在雾化前、第7天比较差异均无统计学意义（ P＞0．05）。结论在对AECOPD机械通气患者进行肝素雾化吸入疗法时，采用氧流量为7 L／min，可明显提高患者的PaO2，降低PaCO2，且对患者的凝血功能影响较小。
목적：탐토불동양류량구동간소무화흡입대만성조새성폐질병급성가중기（ AECOPD）궤계통기환자혈기급응혈공능적영향。방법장51례AECOPD궤계통기환자수궤분위A、B、C삼조，기중A조（17례）급여5 L／min양류량무화흡입；B조（19례）급여7 L／min；C조（15례）급여9 L／min。감측무화전、무화후30 min、1 d、3 d、7 d각개시간점혈기급무화전급무화후제7천적응혈공능삼수적변화정황。결과여A조、C조비교，B조환자재각개감측시간점적양분압（PaO2）、이양화탄분압（PaCO2）급양합지수（PaO2／FiO2）개선최위명현（P＜0．05）；A조여C조비교차이무통계학의의（ P＞0．05）。동일조불동감측시간점여무화전비교，B조무화후각개시간점적PaO2、PaCO2、PaO2／FiO2관찰지표변화명현（P＜0．05）；A조무화30 min후，각개호흡역학지표여무화전비교차이유통계학의의（P＜0．05），이C조무화전후개변불명현（P＞0．05）。삼조활화부분응혈활매시간（ APTT）、응혈매원시간（ PT）、섬유단백원（ FIB）재무화전、제7천비교차이균무통계학의의（ P＞0．05）。결론재대AECOPD궤계통기환자진행간소무화흡입요법시，채용양류량위7 L／min，가명현제고환자적PaO2，강저PaCO2，차대환자적응혈공능영향교소。
Objective To investigate the effects of different amount oxygen-drived inhalation of heparin on arterial blood gas and coagulation function in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) .Methods Fifty-one patients with AECOPD mechanical ventilation were randomly divided into A, B, C three groups.Group A (17 cases) were given the oxygen flow rate of 5 L/min atomizing inhalation, group B (19 cases) were given the oxygen flow rate of 7 L/min, group C (15 cases) were given the oxygen flow rate of 9 L/min.Arterial blood gas and coagulation function were detected before and after atomizing inhalation (30 min, 1, 3, 7 days) in all patients.Results Compared with group A and C, Patients in group B had obviously improved arterial blood gas and were statistically significant (P<0.05), and there was no no statistical significant difference between group A and group C( P >0.05).Compared with before atomization, Patients in group B had significantly improved arterial blood gas at each time point after inhalation ( P<0.05);Patients in group A only showed improved arterial blood gas 30 min after inhalation ( P<0.05);but there was no improvement on all time points in group C (P>0.05).Seven days after inhalation, prothrombin time ( PT) , activated partial thromboplastin time ( APTT) and fibrinogen ( FIB) were not significantly different from the level before inhalation in all three groups (P>0.05).Conclusion The best oxygen flow rate is 7 L/min for heparin inhalation in mechanically ventilated patients with AECOPD.It significantly improves the arterial partial pressure of oxygen, reducing carbon dioxide partial pressure, but has less influence on the coagulation function.