慢性阻塞性肺疾病合并慢性呼吸衰竭患者实施家庭无创通气的意义

The importance of family discontinuous non-invasive-ventilation in the treatment of patients suffering from chronic obstructive pulmonary disease with type Ⅱ respiratory failure

目的评价慢性阻塞性肺疾病（COPD）慢性Ⅱ型呼吸衰竭患者稳定期实施家庭间断无创通气的意义。方法选择COPD稳定期慢性Ⅱ型呼吸衰竭患者13例，治疗前一年内平均发生肺性脑病2～3次，病情稳定期血气PaCO2较高。其中10例为治疗组进行间断无创通气治疗，每日2～3次，每次1小时，患者无创通气期间尽量做深呼吸。3例为对照组仅行常规治疗。结果10例间断无创通气治疗后pH、PaO2、PaCO2和HCO3血气指标达到或接近正常。年平均住院次数、住院天数和住院费（分别为治疗前的33％、17．12％、20．3％）与治疗前均有极显著差异。患者治疗后体力、精力有明显增加，活动后胸闷气短明显减轻，8例可进行适量的户外活动，行走距离大于250m，无明显喘憋。2例可上2～3层楼梯，生活可自理。10例中使用间断家庭无创通气治疗最长者已8年余，血气指标依然维持在较好的水平。对照组治疗前后各项指标则无明显差异。结论家庭间断无创通气治疗是防止COPD慢性呼吸衰竭患者急性发作和肺性脑病，改善生活质量的较好方法，具有良好的经济效益和社会效益。

Objective To evaluate the importance of family discontinuous non-invasive positive pressure ventilation（DNIPPV） in the treatment of patients suffering from chronic obstructive pulmonary disease （COPD） with the type Ⅱ respiratory failure. Methods Thirteen patients suffering from COPD with the type Ⅱ respiratory failure were observed. Pulmonary encephalopathy occured 2 - 3 times every year before DNIPPV,and they had a persistent higher level of PaCOz during COPD stabilization. Ten cases of them had been given DNIPPV, 2-3 times everyday, every time for 1 hour and making deep breath during DNIPPV. Other 3 cases served as control. Results The physical activity significantly improved after DNIPPV treatment,and shortness of breath was alleviated. Eight cases of them could take some outdoor activity. Two of them could take care of themselves. The hospitalization rate, the mean times of the hospitalization and the mean cost decreased significantly （respectively to 33%,17.12%,20.3 % for one year） in DNIPPV group. The levels of arterial blood gas reached or approached normal levels after treatment. There was no improvement in the control group. Conclusions DNIPPV is a good method to prevent pulmonary encephalopathy and to improve quality of life in patient with COPD complicated by type Ⅱ resiratory failure.