[高频胸壁振荡对慢性阻塞性肺疾病急性加重期患者的价值研究]

[A study of the value of high frequency chest wall oscillation in patients with acute exacerbation of chronic obstructive pulmonary disease].

作者信息

Liu Tingting, Kang Yan, Xu Zhaomin, Lyu Yinxia, Jia Lingli, Gao Yun

机构信息

Critical Care Medicine Department, West China Hospital of Sichuan University, Chengdu 610041, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2014 Apr;37(4):255-9.

PMID:24969712

Abstract

OBJECTIVE

To explore the safety and efficacy of high-frequency chest wall oscillation (HFCWO) in invasive mechanical ventilation patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

METHODS

A prospective, randomized, controlled trial was conducted. Thirty-five AECOPD patients with invasive mechanical ventilation were included in the intensive care unit of West China Hospital of Sichuan University from February 2012 to February 2013. The patients were randomly allocated into a HFCWO (H) group and a control group using SAS 9.1 software . The control group received routine therapy, while the H group received HFCWO, along with routine therapy. Invasive mechanical ventilation time, noninvasive ventilation time, total mechanical ventilation time, ICU stay time, hospital stay time and pH, oxygen index (OI) during the first 7 days were collected. At the same time, heart rate, blood pressure, respiratory rate, SpO2 and peak airway pressure before, during and after HFCWO and ventilation alarm of the H group were collected.

RESULTS

The total mechanical ventilation time of patients in the H group was significantly shorter than that of the control group [(10 ± 6) d and (15 ± 8) d, P < 0.05]. But there were no significant differences between the 2 groups in invasive mechanical ventilation time, noninvasive ventilation time, ICU stay and hospital stay time (P > 0.05). There were no significant differences between the 2 groups in pH and oxygen index during the first 7 days (P > 0.05). There were no change in heart rate, blood pressure, respiratory rate, SpO2 and peak airway pressure before, during and after HFCWO in the H group (P > 0.05). Severe ventilator alarm(level 3) occurred in 3.67% patients, but there was no significant correlation between ventilation alarm and patient prognosis.

CONCLUSIONS

HFCWO is very safe and comfortable in ventilated patients with AECOPD. It reduces the total mechanical ventilation time, but cannot improve the prognosis.

摘要

目的

探讨高频胸壁振荡（HFCWO）在慢性阻塞性肺疾病急性加重期（AECOPD）有创机械通气患者中的安全性和有效性。

方法

进行一项前瞻性、随机、对照试验。2012年2月至2013年2月，四川大学华西医院重症监护病房纳入35例接受有创机械通气的AECOPD患者。使用SAS 9.1软件将患者随机分为高频胸壁振荡（H）组和对照组。对照组接受常规治疗，而H组在接受常规治疗的同时接受高频胸壁振荡治疗。收集有创机械通气时间、无创通气时间、总机械通气时间、ICU住院时间、住院时间以及前7天的pH值、氧合指数（OI）。同时，收集H组在高频胸壁振荡治疗前、治疗期间和治疗后的心率、血压、呼吸频率、SpO₂以及气道峰压和通气报警情况。

结果

H组患者的总机械通气时间明显短于对照组[（10±6）天和（15±8）天，P<0.05]。但两组在有创机械通气时间、无创通气时间、ICU住院时间和住院时间方面无显著差异（P>0.05）。两组在前7天的pH值和氧合指数方面无显著差异（P>0.05）。H组在高频胸壁振荡治疗前、治疗期间和治疗后的心率、血压、呼吸频率、SpO₂以及气道峰压均无变化（P>0.05）。3.67%的患者出现严重通气报警（3级），但通气报警与患者预后之间无显著相关性。