CAJ | 학술논문

目的：观察无创双水平正压通气（NIPPV）在重症支气管哮喘患者中的治疗价值。方法选取2012年1月—2014年1月住院治疗的重症支气管哮喘患者60例，按随机数字表法分为观察组和对照组各30例。对照组予以氧疗＋药物治疗，观察组在对照组基础上加用NIPPV治疗。对比2组患者治疗前及治疗后1、12、24、72 h的动脉血气指标、肺功能变化，并随访3个月后的临床疗效。结果与治疗前比较，2组患者治疗1、12、24、72 h后的pH、PaO2和SaO2逐步上升，PaCO2逐步下降（ P均＜0．05）；观察组治疗1、12、24、72 h后的pH、PaO2和SaO2均高于对照组，PaCO2低于对照组（ P均＜0．05）。与治疗前比较，治疗1周后，2组患者的FEV1、FEV1／FVC、PEF均显著升高（P ＜0．05），且观察组的FEV1、FEV1／FVC和PEF较对照组显著升高（ P ＜0．05）。随访3个月后观察组的临床疗效显著高于对照组（93．33％ vs．63．34％，χ2＝3．977， P ＜0．05）。2组患者并发症发生率比较差异无统计学意义（20．0％ vs．10．0％， P ＞0．05）。结论在氧疗和药物治疗的基础上加用NIPPV，可以改善重症支气管哮喘患者的通气情况和肺功能，临床疗效可靠。
목적：관찰무창쌍수평정압통기（NIPPV）재중증지기관효천환자중적치료개치。방법선취2012년1월—2014년1월주원치료적중증지기관효천환자60례，안수궤수자표법분위관찰조화대조조각30례。대조조여이양료＋약물치료，관찰조재대조조기출상가용NIPPV치료。대비2조환자치료전급치료후1、12、24、72 h적동맥혈기지표、폐공능변화，병수방3개월후적림상료효。결과여치료전비교，2조환자치료1、12、24、72 h후적pH、PaO2화SaO2축보상승，PaCO2축보하강（ P균＜0．05）；관찰조치료1、12、24、72 h후적pH、PaO2화SaO2균고우대조조，PaCO2저우대조조（ P균＜0．05）。여치료전비교，치료1주후，2조환자적FEV1、FEV1／FVC、PEF균현저승고（P ＜0．05），차관찰조적FEV1、FEV1／FVC화PEF교대조조현저승고（ P ＜0．05）。수방3개월후관찰조적림상료효현저고우대조조（93．33％ vs．63．34％，χ2＝3．977， P ＜0．05）。2조환자병발증발생솔비교차이무통계학의의（20．0％ vs．10．0％， P ＞0．05）。결론재양료화약물치료적기출상가용NIPPV，가이개선중증지기관효천환자적통기정황화폐공능，림상료효가고。
Objective To observe the therapeutic value of noninvasive bi level positive pressure ventilation ( NIPPV) in patients with severe bronchial asthma .Methods From January 2012 to January 2014 , selected 60 patients with severe bronchial asthma , according to the random number table method , they were divided into the observation group and the control group with 30 cases in each group .The control group was treated with oxygen therapy plus medication , and the observation group was treated with NIPPV on the basis of treatment in the control group .The blood gas and pulmonary function before treatment and 1h, 12h, 24h, 72 h after treatment were compared , and followed up 3 months of the clinical effect .Results Compared with before treatment , 2 groups of patients 1h, 12, 24 h and 72 h after treatment, the pH, PaO2 and SaO2 gradually increased, PaCO2 gradually decreased ( P <0.05);observation group 1h, 12h, 24 h and 72 h after treatment’s pH, PaO2 and SaO2 were higher than those of the control group , and PaCO2 was lower than control group ( P <0.05).Compared with before treatment , after 1 week of treatment , patients in the two groups ’ FEV1 , FEV1/FVC and PEF were significantly in-creased ( P <0.05), and the observation group’s FEV1, FEV1/FVC and PEF were significantly increased than control group ( P <0.05).After 3 months of follow-up, the clinical curative effect of observation group was significantly better than the control group (93.33%vs.63.34%,χ2 =3.977, P <0.05).The incidence of complications between the 2 groups did not show significant differences (20.0% vs.10.0%, P >0.05).Conclusion Based on oxygen therapy and drug treatment , NIPPV can improve ventilation of patients with severe bronchial asthma and lung function with reliable clinical curative effect .