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目的探讨无创机械通气治疗慢性肺源性心脏病合并Ⅱ型呼吸衰竭的临床疗效。方法选取2013年1月—2015年6月海南省保亭黎族苗族自治县人民医院收治的慢性肺源性心脏病合并Ⅱ型呼吸衰竭患者120例。根据治疗意愿,将其分为对照组和观察组各60例。入院后,对照组患者给予常规综合治疗,观察组患者在常规综合治疗的基础上加用无创机械通气治疗,比较两组患者的临床疗效。结果治疗前两组患者呼吸频率、心率比较,差异无统计学意义(P>0.05);治疗后观察组患者的呼吸频率、心率低于对照组(P<0.05);治疗后两组患者呼吸频率、心率均低于治疗前(P<0.05)。治疗前两组患者p H值、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)及血氧饱和度(Sp O2)比较,差异无统计学意义(P>0.05);治疗后观察组患者的p H值、Pa O2及Sp O2高于对照组,Pa CO2低于对照组(P<0.05);治疗后两组患者的p H值、Pa O2及Sp O2均高于治疗前,Pa CO2均低于治疗前(P<0.05)。治疗前两组患者呼吸困难评分比较,差异无统计学意义(P>0.05);治疗后观察组患者呼吸困难评分低于对照组(P<0.05);治疗后两组患者呼吸困难评分均低于治疗前(P<0.05)。治疗前两组患者第1秒用力呼气末容积占预计值百分比(FEV1%)、第1秒用力呼气末容积与用力肺活量比值(FEV1/FVC)比较,差异无统计学意义(P>0.05);治疗后观察组患者的FEV1%、FEV1/FVC高于对照组(P<0.05);治疗后两组患者FEV1%、FEV1/FVC均高于治疗前(P<0.05)。治疗前两组患者血清N末端脑钠肽前体(NT-pro BNP)水平比较,差异无统计学意义(P>0.05);治疗后观察组患者的血浆NT-pro BNP水平低于对照组(P<0.05);治疗后两组患者的血浆NT-pro BNP水平均低于治疗前(P<0.05)。结论无创机械通气治疗可以改善慢性肺源性心脏病合并Ⅱ型呼吸衰竭患者的呼吸困难症状,降低心率和呼吸频率,快速恢复血气分析指标和肺功能指标,临床疗效确切。
Objective To investigate the clinical efficacy of noninvasive mechanical ventilation in treating patients with chronic cor pulmonale complicated with type Ⅱ respiratory failure. Methods A total of 120 patients with chronic pulmonary heart disease and type Ⅱ respiratory failure admitted to the People’s Hospital of Baoting Li-Miao Autonomous County, Hainan Province from January 2013 to June 2015 were selected. According to the wishes of treatment, divided into control group and observation group of 60 cases. After admission, the control group of patients given conventional comprehensive treatment, the observation group of patients on the basis of conventional comprehensive treatment plus non-invasive mechanical ventilation treatment, the clinical efficacy of the two groups were compared. Results There was no significant difference in respiratory rate and heart rate between the two groups before treatment (P> 0.05). After treatment, the respiratory rate and heart rate of the observation group were lower than those of the control group (P <0.05) , Heart rate was lower than before treatment (P <0.05). There were no significant differences in p H, Pa O2, Pa CO2 and Sp O2 between the two groups before treatment (P> 0.05). After treatment, the p H value, Pa O2 and Sp O2 in the observation group were higher than those in the control group, Pa CO2 was lower than that in the control group (P <0.05); after treatment, p H value, Pa O2 and Sp O2 in both groups were higher than Pa CO2 before treatment was lower than before treatment (P <0.05). The scores of dyspnea in the two groups were not significantly different before treatment (P> 0.05). The scores of dyspnea in the observation group were lower than those in the control group after treatment (P <0.05). The scores of dyspnea in both groups were lower than those in the control group Before treatment (P <0.05). The first two seconds of FEV1%, the first second forced end-expiratory volume and forced vital capacity ratio (FEV1 / FVC) were not significantly different between the two groups before treatment (P> 0.05 ). After treatment, FEV1% and FEV1 / FVC in the observation group were significantly higher than those in the control group (P <0.05). After treatment, FEV1% and FEV1 / FVC in both groups were significantly higher than those before treatment (P <0.05). There was no significant difference in serum NT-pro BNP levels between the two groups before treatment (P> 0.05). After treatment, the plasma NT-pro BNP level in the observation group was lower than that in the control group P <0.05). Plasma NT-pro BNP levels in both groups after treatment were lower than those before treatment (P <0.05). Conclusion Noninvasive mechanical ventilation can improve the symptoms of dyspnea, reduce heart rate and respiratory rate in patients with chronic cor pulmonale complicated with type Ⅱ respiratory failure, and quickly recover the blood gas analysis and pulmonary function indexes. The clinical curative effect is definite.