四川省30 家综合医院无创正压通气治疗过程中供氧浓度和吸入氧浓度的调查研究

Survey of noninvasive positive pressure ventilation in treatment of AECOPD patients in 30 hospitals in Sichuan province

摘要:

目的 了解无创正压通气（NPPV）治疗慢性阻塞性肺疾病急性加重期（AECOPD）伴Ⅱ型呼吸衰竭患者的供氧浓度和吸入氧浓度现状，为提高无创呼吸机治疗效果提供实证依据。方法 采用横断面研究设计对四川省30 家综合性医院的呼吸内科病房终端氧浓度、呼吸机出口端氧浓度和接受NPPV 治疗的AECOPD 伴Ⅱ型呼吸衰竭患者鼻/ 面罩内实际吸入氧浓度进行测量或统计。结果 30 家医院均为医院中心供氧，其供氧方式有3 种：分子筛制氧机供氧5 个（16.7%）；液态氧供氧7 个（23.3%）；以制氧机和液态氧的混合供氧18个（60.0%）。病房终端总体供氧浓度为（85.60±5.65），呼吸机出口端氧浓度低于治疗氧浓度预设值（P <0.05）。同时给予40% 给氧浓度时，鼻/ 面罩内实测吸入氧浓度为（33.36±1.29），且吸入氧浓度随着吸气相正压（IPAP）升高有下降趋势。结论 相关部门必须加强对病房终端、呼吸机出口端以及鼻/ 面罩内实际吸入氧浓度的质量监测，并根据监测结果适度提高NPPV 治疗过程中治疗氧浓度预设值，从而保障患者有效的氧疗。

Abstract:

Objective To investigate the oxygen concentration and inspired oxygen concentration of noninvasive positive pressure ventilation (NPPV) in treatment of patients with AECOPD accompanied with type II respiratory failure. Methods A cross-sectional design survey was carried out in department of respiratory medicine wards of 30 comprehensive hospitals of Sichuan province to measure oxygen concentration, oxygen concentration of the ventilator exit, and actual oxygen concentration through nasal mask or mask. Results Central oxygen supply was utilized in all 30 hospitals with 3 oxygen delivering methods: molecular sieve oxygen generator (5, 16.7%), liquid oxygen tank (7, 23.3%), and combination of oxygen generator and liquid oxygen tank (18, 60.0%). The average oxygen concentration was (85.60 ± 5.65) % which is lower than anticipated. Actual oxygen concentration is (33.36 ± 1.29) % when 40% of FiO2 was provided, which declined with the increase of IPAP. Conclusion More work should be done to monitor the oxygen concentration of central oxygen supply, ventilator exit and actual oxygen concentration when using nasal mask or mask. Upregulation of oxygen concentration should be provided when providing oxygen for the patients with AECOPD and type II respiratory failure.