目的 对比无创间歇期雾化与无创同时雾化对慢性阻塞性肺疾病急性加重患者雾化过程中经皮二氧化碳分压（PtCO2）动态变化及治疗效果的影响。 方法 采用随机平行对照试验方法，便利抽样选取2021年10月至2022年9月常州市第一人民医院收治慢性阻塞性肺疾病急性加重患者70例，根据随机数字表法分为对照组和试验组各35例，对照组给予无创间歇期雾化吸入，试验组给予无创同时雾化吸入，观察2组雾化0、5、10、15 min（雾化结束点）的PtCO2数值，记录每日的动脉血气分析指标（主要包括PaCO2、PaO2、pH），记录治疗前、治疗第4天、治疗第7天临床肺部感染评分和慢性阻塞性肺疾病患者自我评估评分。 结果 最终纳入对照组和试验组各33例患者。对照组男25例，女8例，年龄（75.33 ± 8.24）岁；试验组男25例，女8例，年龄（72.39 ± 8.56）岁。对照组患者雾化0、5、10、15 min PtCO2数值分别为（63.83 ± 12.47）、（64.40 ± 12.57）、（65.42 ± 13.77）、（66.62 ± 14.59） mmHg（1 mmHg=0.133 kPa），各时间点PtCO2之间总体上差异有统计学意义（F=8.05，P<0.01），进一步采用Sidak法两两比较显示雾化15 min与雾化0、5、10 min的PtCO2差异均有统计学意义（均P<0.05），试验组雾化0、5、10、15 min PtCO2数值分别为（67.62 ± 11.89）、（67.15 ± 12.12）、（67.82 ± 12.22）、（68.15 ± 12.09） mmHg，各时间点PtCO2之间总体上差异无统计学意义（F=2.00，P>0.05）；2组患者PaCO2和pH值均随治疗时间好转，但对照组最早在治疗第4天开始与治疗前比较差异有统计学意义（P<0.05），而试验组在治疗第2天开始与治疗前比较差异有统计学意义（P<0.05）。 结论 2种雾化方式均取得良好的治疗效果，但无创同时雾化在雾化过程中更能维持PtCO2的平稳，安全性更高，且能够更早改善患者动脉血气指标PaCO2和pH值，是无创通气与雾化治疗联合运用尤其是患者伴有高碳酸血症时更宜选择的雾化方式。 Objective To compare the dynamic changes of transcutaneous partial pressure of carbon dioxide (PtCO2) and treatment effect of non-invasive intermittent nebulization and non-invasive simultaneous nebulization in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods This was a randomized parallel controlled trial study. A total of 70 patients with acute exacerbation of COPD in Changzhou First People′s Hospital from October 2021 to September 2022 were selected by convenience sampling method, and divided into control group and experimental group by randomized digits table method with 35 cases in each group. The control group was given non-invasive intermittent oxygen-driven nebulization, and the experimental group was given non-invasive simultaneous oxygen-driven nebulization. The PtCO2 values at 0, 5, 10, 15 min (the end point of atomization) of the 2 groups were observed, the daily arterial blood gas analysis indexes (mainly including PaCO2, PaO2 and pH) were recorded, and the clinical pulmonary infection score and the self-assessment score of COPD patients were recorded before treatment, on the 4th and 7th day of treatment. Results Finally, 33 patients were included in both the control group and the experimental group. There were 25 males and 8 females in the control group, aged (75.33 ± 8.24) years old. There were 25 males and 8 females in the experimental group, aged (72.39 ± 8.56) years old. The PtCO2 values at 0, 5, 10, 15 min in the control group were (63.83 ± 12.47), (64.40 ± 12.57), (65.42 ± 13.77), (66.62 ± 14.59) mmHg (1 mmHg=0.133 kPa). There were statistically significant differences in PtCO2 at all time points (F=8.05, P<0.01). Further pairwise comparison by Sidak method showed that there were statistically significant differences in PtCO2 at 15 min compared with 0, 5, 10 min (all P<0.05). The PtCO2 values at 0, 5, 10, 15 min in the experimental group were (67.62 ± 11.89), (67.15 ± 12.12), (67.82 ± 12.22), (68.15 ± 12.09) mmHg. There was no statistically significant difference in PtCO2 at all time points (F=2.00, P>0.05). The PaCO2 and pH value of the two groups were improved with the treatment time, the control group had a statistically significant difference on the 4th day of treatment compared with before treatment (P<0.05), while the experimental group on the second day of treatment compared with before treatment (P<0.05). Conclusions Both kinds of nebulization have achieved good therapeutic effects, but non-invasive simultaneous nebulization can better maintain the stability of PtCO2 in the process of nebulization with higher safety, and can improve the arterial blood gas index PaCO2 and pH value of patients earlier, which is a more suitable nebulization method for the combination of non-invasive ventilation and nebulization, especially for patients with hypercapnia.
Comparison of different atomizing inhalation times on noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease
Objective To compare the dynamic changes of transcutaneous partial pressure of carbon dioxide (PtCO2) and treatment effect of non-invasive intermittent nebulization and non-invasive simultaneous nebulization in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods This was a randomized parallel controlled trial study. A total of 70 patients with acute exacerbation of COPD in Changzhou First People′s Hospital from October 2021 to September 2022 were selected by convenience sampling method, and divided into control group and experimental group by randomized digits table method with 35 cases in each group. The control group was given non-invasive intermittent oxygen-driven nebulization, and the experimental group was given non-invasive simultaneous oxygen-driven nebulization. The PtCO2 values at 0, 5, 10, 15 min (the end point of atomization) of the 2 groups were observed, the daily arterial blood gas analysis indexes (mainly including PaCO2, PaO2 and pH) were recorded, and the clinical pulmonary infection score and the self-assessment score of COPD patients were recorded before treatment, on the 4th and 7th day of treatment. Results Finally, 33 patients were included in both the control group and the experimental group. There were 25 males and 8 females in the control group, aged (75.33 ± 8.24) years old. There were 25 males and 8 females in the experimental group, aged (72.39 ± 8.56) years old. The PtCO2 values at 0, 5, 10, 15 min in the control group were (63.83 ± 12.47), (64.40 ± 12.57), (65.42 ± 13.77), (66.62 ± 14.59) mmHg (1 mmHg=0.133 kPa). There were statistically significant differences in PtCO2 at all time points (F=8.05, P<0.01). Further pairwise comparison by Sidak method showed that there were statistically significant differences in PtCO2 at 15 min compared with 0, 5, 10 min (all P<0.05). The PtCO2 values at 0, 5, 10, 15 min in the experimental group were (67.62 ± 11.89), (67.15 ± 12.12), (67.82 ± 12.22), (68.15 ± 12.09) mmHg. There was no statistically significant difference in PtCO2 at all time points (F=2.00, P>0.05). The PaCO2 and pH value of the two groups were improved with the treatment time, the control group had a statistically significant difference on the 4th day of treatment compared with before treatment (P<0.05), while the experimental group on the second day of treatment compared with before treatment (P<0.05). Conclusions Both kinds of nebulization have achieved good therapeutic effects, but non-invasive simultaneous nebulization can better maintain the stability of PtCO2 in the process of nebulization with higher safety, and can improve the arterial blood gas index PaCO2 and pH value of patients earlier, which is a more suitable nebulization method for the combination of non-invasive ventilation and nebulization, especially for patients with hypercapnia.
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