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目的探讨俯卧位通气联合常规疗法治疗慢性阻塞性肺疾病急性加重期(AECOPD)行有创机械通气患者的临床应用价值。方法选择2013年1月至2014年1月收治的行有创通气的AECOPD患者60例,随机分为观察组和对照组,每组各30例。对照组患者给予常规疗法,观察组在常规疗法基础上,给予俯卧位通气,白天进行俯卧位通气6 h(其余时间为仰卧位通气),连续7 d。比较两组患者治疗后的动脉氧分压(Pa O2)、氧合指数(Pa O2Fi O2)及临床疗效。结果 (1)两组患者治疗后第1 d、第3 d、第5 d及第7 d的Pa O2相比较,差异无统计学意义(P均>0.05);观察组患者治疗后第3 d、第5 d及第7 d的Pa O2/Fi O2明显高于对照组,差异有统计学意义(P均<0.05)。(2)观察组治疗总有效率(86.6%)稍高于对照组(80.0%),但差异无统计学意义(P>0.05)。结论对AECOPD患者实施俯卧位通气联合常规疗法,可明显提高患者的氧合指标,并有提高AECOPD患者临床疗效的趋势,但尚需进行大样本研究证实。
Objective To investigate the clinical value of prone ventilation and conventional therapy in the treatment of patients with invasive mechanical ventilation during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Sixty AECOPD patients admitted to our hospital from January 2013 to January 2014 were randomly divided into observation group and control group, with 30 cases in each group. The patients in the control group were given conventional therapy. The observation group was given prone position ventilation on the basis of routine therapy. During the day, the patients in the prone position were ventilated for 6 hours (the supine position was ventilated for the rest of the day) for 7 days. The arterial oxygen tension (Pa O2), oxygenation index (Pa O2 Fi O2) and clinical efficacy were compared between the two groups. Results (1) There was no significant difference in Pa O2 between the two groups on the 1st, 3rd, 5th and 7th day after treatment (all P> 0.05). On the 3rd day PaO2 / FiO2 on day 5 and day 7 were significantly higher than those in control group (all P <0.05). (2) The total effective rate of observation group (86.6%) was slightly higher than that of control group (80.0%), but the difference was not statistically significant (P> 0.05). Conclusions Prostate ventilation combined with conventional therapy in AECOPD patients can significantly improve the oxygenation index of patients and improve the clinical curative effect of AECOPD patients. However, large sample studies are still needed.