2024 年第 9 期 第 0 卷

肺内振荡和肺扩张治疗慢性阻塞性肺疾病急性加重的效果研究

Effect of intrapulmonary oscillation and lung expansion in the treatment of acute exacerbation of chronic obstructive pulmonary disease

作者：薛翔赵炜贾凌杨敬辉蔡建芹陈昆仑陈娇

英文作者：Xue Xiang Zhao Wei Jia Ling Yang Jinghui Cai Jianqin Chen Kunlun Chen Jiao

单位：南京医科大学附属逸夫医院重症医学科，南京211100

英文单位：Department of Critical Care Medicine Sir Run Run Hospital Nanjing Medical University Nanjing 211100 China

关键词：慢性阻塞性肺疾病；急性加重；振荡；肺扩张

英文关键词：Chronicobstructivepulmonarydisease;Acuteexacerbation;Oscillations;Lungexpansion

• 摘要：

• 目的 探讨肺内振荡和肺扩张（OLE）治疗在慢性阻塞性肺疾病急性加重（AECOPD）患者中的治疗效果。方法 选取南京医科大学附属逸夫医院重症医学科2022年4月至2023年12月收治的108例AECOPD患者为研究对象，采用随机数字表法将患者分为观察组和对照组，各54例。对照组给予常规胸部物理治疗方法；观察组给予OLE治疗。比较2组患者治疗后1、3、5 d痰量、氧分压、二氧化碳分压、呼吸频率、心率、第1秒用力呼气容积（FEV1）、FEV1与用力肺活量比值（FEV1/FVC）、FEV1占预计值百分比（FEV1%）。比较2组无创呼吸机（NIV）使用率、重症监护病房（ICU）住院时间及28 d死亡率。结果 治疗后1、3 d，观察组痰量均多于对照组，治疗后5 d少于对照组（均P<0.05）。治疗后1、3、5 d，2组氧分压均呈上升趋势，且观察组各时点均高于对照组，2组二氧化碳分压、呼吸频率、心率均呈下降趋势，且观察组各时点均低于对照组（均P<0.05）。治疗后1、3、5 d，2组FEV1、FEV1/FVC、FEV1%均呈上升趋势，且观察组各时间点均高于对照组（均P<0.05）。观察组NIV使用率和ICU住院时间均低于/短于对照组［11.1%（6/54）比24.1%（13/54）、（6.2±2.2）d比（8.5±3.8）d］（均P＜0.05），28 d死亡率与对照组比较差异无统计学意义［1.9%（1/54）比3.7%（2/54）］（χ2=1.025，P=0.074）。结论 OLE治疗可促进AECOPD患者排痰，改善氧合和通气功能，降低NIV使用率，缩短ICU住院时间,且安全可耐受。

• Objective To investigate the therapeutic effect of intrapulmonary oscillation and lung expansion (OLE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 108 AECOPD patients admitted to the Department of Critical Care Medicine, Sir Run Run Hospital, Nanjing Medical University from April 2022 to December 2023 were selected as the research objects. The patients were divided into observation group and control group by random number table method, with 54 cases in each group. The control group was given conventional chest physical therapy. The observation group was treated with OLE. Sputum volume, partial pressure of oxygen, partial pressure of carbon dioxide, respiratory rate, heart rate, forced expiratory volume in the first second (FEV1), ratio of FEV1 to forced vital capacity (FEV1/FVC) and percentage of FEV1 to predicted value (FEV1%) were compared between the two groups at the 1, 3 and 5 d after treatment. The utilization rate of non-invasive ventilator (NIV), length of stay in intensive care unit (ICU) and 28 d mortality were compared between the two groups. Results The sputum volume of the observation group was higher than that of the control group 1 and 3 d after treatment, and was lower than that of the control group 5 d after treatment (all P<0.05). At the 1, 3 and 5 d after treatment, the partial pressure of oxygen in the two groups increased, and in the observation group was higher than that in the control group, and the partial pressure of carbon dioxide, respiratory rate and heart rate in the two groups decreased, and in the observation group were lower than those in the control group. At the 1, 3 and 5 d after treatment, FEV1, FEV1/FVC and FEV1% in the two groups increased, and those in the observation group were higher than those in the control group at each time point (all P<0.05). The utilization rate of NIV and the length of ICU stay in the observation group were lower/shorter than those in the control group ［11.1%(6/54) vs 24.1%(13/54), (6.2±2.2)d vs (8.5±3.8)d］(both P<0.05). There was no significant difference in 28 d mortality between the observation group and the control group［1.9%（1/54） vs 3.7%（2/54）］（χ2=1.025， P=0.074）. Conclusion OLE can promote sputum excretion, improve oxygenation and ventilation function, reduce the utilization rate of NIV and shorten the length of ICU stay in patients with AECOPD.