体外膈肌起搏器联合无创通气治疗慢性阻塞性肺疾病的临床研究

侯红梅 肖芸 谢俊玲

【摘要】 目的：探究體外膈肌起搏器联合无创正压通气在慢性阻塞性肺疾病（COPD）患者中的临床效果及对肺功能的影响。方法：随机选取2016年1月-2018年3月本院收治的50例慢性阻塞性肺疾病患者，根据患者入院治疗单双号分为试验组与对照组，每组25例。对照组采用无创正压通气治疗，试验组采用体外膈肌起搏器联合无创正压通气治疗。分别观察两组临床治疗效果、肺功能（PaO2、PaCO2、PaO2/FiO2、FEV1/FVC、FEV1）、日常生活活动能力量表（ADL）评分。结果：治疗后2周，试验组临床治疗总有效率92.00%高于对照组68.00%，差异有统计学意义（P<0.05）;试验组ADL评分（94.64±5.17）分高于对照组（85.71±4.31）分，差异有统计学意义（P<0.05）;试验组PaCO2（53.22±3.41）mm Hg、PaO2（89.62±2.41）mm Hg、PaO2/FiO2（410.82±11.97）mm Hg均优于对照组（61.91±3.12）mm Hg、（80.87±2.87）mm Hg、（324.39±12.57）mm Hg，FEV1/FVC、FEV1均高于对照组，两组比较差异均有统计学意义（P<0.05）。结论：与单一使用无创正压通气治疗相比，给予COPD患者使用体外膈肌起搏器联合无创正压通气不仅利于提升临床治疗效果，更利于改善其肺功能，进而提升日常生活活动能力，具有独特的应用价值，值得临床进一步推广应用。

【关键词】 体外膈肌起搏; 无创正压通气; 慢性阻塞性肺; 肺功能

【Abstract】 Objective：To explore the clinical effect of external diaphragm pacemaker combined with non-invasive positive pressure ventilation in patients with chronic obstructive pulmonary disease（COPD）and its effect on pulmonary function.Method：A total of 50 patients with chronic obstructive pulmonary disease were randomly selected from January 2016 to March 2018.According to the odd and even number of admission treatment，they were divided into experimental group and control group，25 cases in each group.The control group was treated with non-invasive positive pressure ventilation.The experimental group was treated with external diaphragm pacemaker combined with non-invasive positive pressure ventilation.The clinical effect，pulmonary function（PaO2，PaCO2，PaO2/FiO2，FEV1/FVC，FEV1）and activity of daily living（ADL）scores of two groups were observed.Result：After treatment two weeks，the total effective rate of the experimental group was 92.00% higher than the control group of 68.00%，the difference was statistically significant（P<0.05）.The ADL score of the experimental group was（94.64±5.17）score higher than the control group of（85.71±4.31）score，the difference was statistically significant（P<0.05）.The PaCO2（53.22±3.41）mm Hg，PaO2（89.62±2.41）mm Hg，PaO2/FiO2（410.82±11.97）mm Hg of the experimental group were better than the control group of（61.91±3.12）mm Hg，（80.87±2.87）mm Hg，（324.39±12.57）mm Hg，the levels of FEV1/FVC、FEV1 in the experimental group were higher than those of the control group，the differences were statistically significant（P<0.05）.Conclusion：Compare with the single use of non-invasive positive pressure ventilation，the external diaphragm pacemaker combined with non-invasive positive pressure ventilation in the treatment for patients with COPD is not only conducive to improve the clinical efficacy，but also conducive to improve their pulmonary function，and thus enhance the ability of daily living，has a unique application value.It is worthy further of clinical application.

【Key words】 External diaphragm pacing; Noninvasive positive pressure ventilation; Chronic obstructive pulmonary disease; Pulmonary function

First-authors address：Yuebei Peoples Hospital，Shaoguan 512025，China

doi：10.3969/j.issn.1674-4985.2019.16.037

慢性阻塞性肺疾病（COPD）简称为慢阻肺，是常见的呼吸道疾病中的小气道疾病，一般表现为咳痰、气短、呼吸困难、胸闷、咳嗽持续时间长等症状。当前临床还未明确COPD发病原因，部分临床研究学者认为与环境因素、个体因素、慢支和阻塞性肺气肿相互作用发生有关，具有较高的致死率[1]。如若得不到及时治疗，严重者可在短时间内病情加重，气道受损，出现合并呼吸衰竭症状，因此COPD患者常需要给予针对性的治疗与改善症状措施，避免造成严重的后果。无创正压通气应具有操作简单、安全性高被临床广泛应用于治疗COPD中，但由于该治疗方法需要长时间治疗，在此过程中患者治疗依从性会逐渐下降，削弱治疗效果;体外膈肌起搏器是一种新型的治疗方式，利于加快患者病情恢复[2]。鉴于此，本文旨在探究支气管镜联合无创正压通气在COPD患者中的临床效果及对肺功能的影响，现报道如下。……