目的 比较无创通气间歇期氧气驱动雾化、无创通气间歇期空气驱动雾化、无创通气同时空气驱动雾化对慢性阻塞性肺疾病急性加重（AECOPD）患者雾化过程中二氧化碳分压、氧饱和度（SpO₂）及心率的动态变化及治疗效果的影响。 方法 根据随机对照研究的方法将99例需使用无创通气及雾化吸入治疗的慢性阻塞性肺疾病急性加重患者根据计算机产生的随机数字表随机分为对照组、观察一组、观察二组各33例，对照组给予无创通气间歇期氧气驱动雾化吸入，观察一组给予无创通气间歇空气驱动雾化，观察二组给予无创通气同时空气驱动雾化，记录雾化0、5、10、15 min和雾化结束5、10、15 min的经皮二氧化碳分压（PtCO₂）、SpO₂及心率变化。记录治疗前至治疗第7天每天早晨动脉血气PaCO₂、PaO₂数值，记录三组住院时间。 结果 三组雾化过程中PtCO₂对比结果显示，时间主效应和时间组别交互效应差异均有统计学意义（P < 0.001），且对照组PtCO₂数值与时间呈线性关系（F = 10.166，P = 0.003），随时间变化呈上升状态；观察一组各时间点PtCO₂数值与时间呈线性关系（F = 10.544，P = 0.003），随时间变化呈下降状态；观察二组各时间点PtCO₂数值与时间呈线性关系（F = 20.003，P < 0.001），随时间呈下降状态。再分别对三组每个时间点PtCO₂数值进行多样本方差分析，对照组雾化15 min PtCO₂高于观察一组、观察二组；观察一组、观察二组均与对照组雾化前后PtCO₂差值（dPtCO₂）差异有统计学意义（P < 0.05）；对三组雾化结束观察期每个时间点PtCO₂数值进行多样本方差分析，结果显示三组雾化结束0 min PtCO₂、雾化结束5 min PtCO₂差异有统计学意义（P < 0.05），雾化结束10 min PtCO₂、雾化结束15 min PtCO₂三组差异无统计学意义（P > 0.05）；三组雾化过程中SpO₂对比显示三组时间组别交互效应差异均有统计学意义（P < 0.05）。且观察一组各时间点SpO₂数值随时间呈下降趋势。对照组雾化10 min SpO₂、雾化15 min SpO₂高于观察一组和观察二组；三组均能使动脉血气中PaCO₂随治疗时间的增加而好转（P < 0.05）。 结论 三种雾化治疗方式均能取得良好的治疗效果，但无创通气间歇期氧气驱动雾化会使雾化过程中PtCO₂及SpO₂上升；无创通气间歇期空气驱动雾化会使雾化过程中PtCO₂及SpO₂下降；无创通气同时空气驱动雾化使雾化过程中PtCO₂下降及保持SpO₂平稳，因此无创通气同时空气驱动雾化是相对更加安全的雾化吸入方式，值得临床推广。

Objective To compare the effects of non-invasive intermittent oxygen-driven nebulization， non-invasive intermittent air-driven nebulization， and non-invasive simultaneous air-driven nebulization on the dynamic changes of partial pressure of carbon dioxide （PtCO₂）， pulse oxygen saturation （SpO₂）， and heart rate during nebulization， as well as the therapeutic effects in patients with acute exacerbation of chronic obstructive pulmonary disease （COPD）. Methods A total of 99 patients with acute exacerbation of COPD requiring non-invasive mechanical ventilation and nebulization were randomly divided into a control group， an experimental group one， and an experimental group two， with 33 patients in each group. The control group was given non-invasive intermittent oxygen-driven nebulization， the experimental group one was given non-invasive intermittent air-driven nebulization， and the experimental group two was given non-invasive simultaneous air-driven nebulization. The changes in PtCO₂， SpO₂， and heart rate at 0 min， 5 min， 10 min， 15 min during nebulization， 5 min， 10 min， and 15 min after nebulization were recorded. The values of arterial blood gas PaCO₂ and PaO₂ were recorded every morning from before treatment to the 7th day of treatment. The length of hospital stay in the three groups was also recorded. Results The comparison of PtCO₂ during nebulization among the three groups showed that there were statistically significant differences in the main effect of time and the interaction effect of time and group （P < 0.001）. The PtCO₂ values in the control group showed a linear relationship with time （F = 10.166， P = 0.003）， increasing over time； the PtCO₂ values in the experimental group one showed a linear relationship with time （F =10.544， P = 0.003）， decreasing over time； the PtCO₂ values in the experimental group two showed a linear relationship with time （F = 20.003， P < 0.001）， decreasing over time. A one-way ANOVA was conducted on the PtCO₂ values at each time point in the three groups. The PtCO₂ value at 15 min of nebulization in the control group was higher than that in the experimental group one and the experimental group two. There were statistically significant differences in the difference in PtCO₂ before and after nebulization （dPtCO₂） between the experimental group one and the experimental group two and the control group （P<0.05）. A one-way ANOVA was conducted on the PtCO₂ values at each time point during the observation period after nebulization. The results showed that there were statistically significant differences in PtCO₂ at 0 min and 5 min after nebulization among the three groups （P < 0.05）， while there were no statistically significant differences in PtCO₂ at 10 min and 15 min after nebulization among the three groups （P > 0.05）. The comparison of SPO₂ during nebulization among the three groups showed that there were statistically significant differences in the interaction effect of time and group （P < 0.05）. The SPO₂ values in the experimental group one decreased over time. The SPO₂ values at 10 min and 15 min of nebulization in the control group were higher than those in the experimental group one and the experimental group two. All three groups could improve PaCO₂ in arterial blood gas with the treatment days （P<0.05）. Conclusions All three nebulization treatment methods can achieve good therapeutic effects. However， non-invasive intermittent oxygen-driven nebulization can increase PtCO₂ and SPO₂ during nebulization； non-invasive intermittent air-driven nebulization can decrease PtCO₂ and SPO₂ during nebulization； non-invasive simultaneous air-driven nebulization can decrease PtCO₂ and maintain stable SPO₂ during nebulization. Therefore， non-invasive simultaneous air-driven nebulization is a relatively safer nebulization inhalation method and is worthy of clinical promotion.