三种雾化吸入方法对无创通气的慢性阻塞性肺疾病急性加重患者的疗效影响

doi:10.3969/j.issn.1006-5725.2025.11.013

Abstract

Abstract:

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 PtCO₂values in the experimental group one showed a linear relationship with time （F =10.544， P = 0.003）， decreasing over time； the PtCO₂values 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 PtCO₂values 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 PtCO₂before 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 PtCO₂at 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 PtCO₂and SPO₂during nebulization； non-invasive intermittent air-driven nebulization can decrease PtCO₂and SPO₂during 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.

Key words: acute exacerbation of chronic obstructive pulmonary disease, noninvasive ventilation, non-invasive intermittent oxygen-driven nebulization, non-invasive intermittent air-driven nebulization, non-invasive simultaneous air-driven nebulization, percutaneous blood gas monitoring

CLC Number:

R473.5

Yan YANG,Li YAO,Wenxia WAN,Zhenzhen ZHOU,Nan LING. Evaluation of the effect of three nebulizing inhalation methods on patients with acute exacerbation of chronic obstructive pulmonary disease treated by non⁃invasive ventilation[J]. The Journal of Practical Medicine, 2025, 41(11): 1694-1704.

Figures/Tables 9

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References 38

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项目	对照组（n = 33）	观察一组（n = 33）	观察二组（n = 33）	F/χ²值	P值
年龄（x ± s）/岁	74.91 ± 9.37	73.48 ± 11.83	72.06 ± 10.17	0.856	0.428
BMI（x ± s）/（kg/m²）	22.97 ± 4.55	22.42 ± 3.69	21.78 ± 3.75	0.863	0.425
APACHE Ⅱ（x ± s）/分	15.05 ± 4.90	13.16 ± 5.05	12.61 ± 4.58	1.479	0.233
性别				1.391	0.499
男	23（69.70）	24（72.73）	27（81.82）
女	10（33.30）	9（27.27）	6（18.18）
吸烟史				0.683	0.711
有	22（66.67）	23（69.70）	25（75.76）
无	11（33.33）	10（30.30）	8（24.24）
GOLD分级				1.500	0.827
Ⅱ级	2（6.06）	4（12.12）	4（12.12）
Ⅲ级	22（66.67）	21（63.64）	23（69.70）
Ⅳ级	9（27.27）	8（24.24）	6（18.18）
高血压				3.226	0.199
有	20（60.61）	22（66.67）	15（45.45）
无	13（39.39）	11（33.33）	18（54.55）
糖尿病				0.306	0.858
有	9（27.27）	8（24.24）	10（30.30）
无	24（72.72）	25（75.76）	23（69.70）
心脏病				2.268	0.322
有	15（45.45）	13（39.39）	19（57.58）
无	18（54.55）	20（60.61）	14（42.42）

组别	例数	雾化过程中PtCO₂
组别	例数	0 min	5 min	10 min	15 min	F值	P值
对照组	33	64.75 ± 11.35	64.37 ± 11.57	66.42 ± 12.54	67.59 ± 13.50	9.150	< 0.01
观察一组	33	62.51 ± 8.71	61.08 ± 9.20	60.29 ± 9.91	59.16 ± 9.57^?	9.370	< 0.01
观察二组	33	64.92 ± 10.07	62.49 ± 8.71	61.28 ± 8.73	60.25 ± 8.02^?	20.192	< 0.01
F值		0.433	0.862	2.008	4.362
P值		0.650	0.425	0.140	0.015
组别效应		F = 1.430，P = 0.244
时间效应		F = 8.655，P < 0.001
时间*组别		F = 14.537，P < 0.001

组别	例数	雾化结束后PtCO₂
组别	例数	0 min	5 min	10 min	15 min	F值	P值
对照组	33	67.59 ± 13.56	64.51 ± 12.59	63.13 ± 13.72	62.08 ± 11.33	21.560	< 0.01
观察一组	33	59.16 ± 9.57^?	58.12 ± 9.91^?	57.04 ± 9.91	56.27 ± 10.24	27.587	< 0.01
观察二组	33	60.25 ± 8.02^?	59.31 ± 7.14^?	59.36 ± 7.78	58.63 ± 7.63	4.621	0.005
F值		4.362	3.728	2.557	2.427
P值		0.015	0.028	0.083	0.094
组别效应		F = 3.261，P = 0.043
时间效应		F = 43.210，P < 0.001
时间*组别		F = 4.782，P < 0.001

组别	例数	dPtCO₂	F值	P值
对照组	33	2.79 ± 4.92	21.401	< 0.001
观察一组	33	-3.48 ± 5.06^?
观察二组	33	-4.83 ± 5.16^?

组别	例数	雾化过程中SpO₂
组别	例数	0 min	5 min	10 min	15 min	F值	P值
对照组	33	96.63 ± 4.87	98.25 ± 2.55	98.38 ± 2.77	98.88 ± 2.42	1.809	0.176
观察一组	33	96.49 ± 3.34	95.12 ± 3.67	93.11 ± 3.43^?	91.12 ± 3.32^?	5.463	0.021
观察二组	33	95.57 ± 2.23	95.13 ± 2.51	93.89 ± 4.65^?	93.03 ± 1.64^?	3.345	0.074
F值		0.341	2.321	5.325	5.679
P值		0.924	0.178	0.014	0.010
组别效应		F = 4.341，P = 0.052
时间效应		F = 3.093，P = 0.058
时间*组别		F = 4.230，P = 0.005

Evaluation of the effect of three nebulizing inhalation methods on patients with acute exacerbation of chronic obstructive pulmonary disease treated by non⁃invasive ventilation

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时间	对照组（n = 33）	观察一组（n = 33）	观察二组（n = 33）	组别效应	时间效应	组别*时间
治疗前	71.98 ± 12.34	69.23 ± 10.14	73.43 ± 10.71
第2天	68.15 ± 12.01	59.54 ± 11.37^?	65.98 ± 11.40^?
第3天	66.14 ± 11.02	57.46 ± 12.54^?	62.46 ± 9.55^?
第4天	62.21 ± 10.13^?	57.35 ± 9.26^?	62.47 ± 8.64^?
第5天	60.11 ± 8.35^?	56.66 ± 8.43^?	60.32 ± 9.44^?
第6天	59.23 ± 8.92^?	54.33 ± 6.95^?	59.85 ± 8.23^?
第7天	57.62 ± 8.01^?	50.54 ± 6.04^?	57.77 ± 8.43^?
F值	18.54	17.342	19.032	0.193	58.042	1.091
P值	< 0.001	0.001	0.001	0.973	0.001	0.537

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组别	例数	雾化结束后SpO₂
组别	例数	0 min	5 min	10 min	15 min	F值	P值
对照组	33	98.88 ± 2.42	97.75 ± 3.73	96.50 ± 4.14	97.00 ± 2.56	2.750	0.068
观察一组	33	91.12 ± 3.32	94.97 ± 4.57	95.65 ± 3.99	95.00 ± 3.24	0.943	0.383
观察二组	33	93.03 ± 1.64	96.45 ± 1.62	96.34 ± 1.63	95.83 ± 1.78	8.760	0.006
F值		5.679	3.230	0.353	1.340
P值		0.010	0.109	0.600	0.293
组别效应		F = 2.311，P = 0.141
时间效应		F = 1.321，P = 0.871
时间*组别		F = 3.054，P = 0.011