不同治疗方法对晚期慢性阻塞性肺疾病呼吸衰竭患者预后的影响

The effects of different therapies to prognosis of chronic obstructive pulmonary disease complicated by respiratory failure

目的探讨晚期慢性阻塞性肺疾病（COPD）患者临床缓解期最佳的治疗方法。方法将47例晚期COPD患者分为三组：A组为不能或不接受家庭氧疗和家庭无创正压通气（NPPV）者；B组为出院后在医生指导下进行长期家庭氧疗者；C组为能在医生指导下进行长期家庭NPPV加长期家庭氧疗，且能很好耐受者。回顾性对比分析三组患者1年内再住院率、再插管率及病死率。结果B组患者1年内的再住院率、再插管率及病死率较A组分别降低了38．4％、17．3％和18．0％，而C组患者较B组患者又降低了8．0％、35．3％和29．4％，三组患者的再住院率、再插管率及病死率比较，差异均有统计学意义（P〈0．05）。结论长期家庭氧疗和长期家庭NPPV能显著降低晚期COPD患者的再住院率、再插管率和病死率，长期家庭氧疗加长期家庭NPPV治疗效果最好。

Objective To study the best therapy of clinical eatabasis in patients at advanced stage of chronic obstructive pulmonary disease （COPD）. Method Forty-seven patients with COPD at advanced stage were divided into three groups, A group was the patients who couldn＇t or didn＇t receive domiciliary oxygen therapy and domiciliary non-invasive positive pressure ventilation （NPPV）, B group was those who received long-term domiciliary oxygen therapy, C group was those who received long-term domiciliary oxygen therapy plus long-term domiciliary NPPV. Readmission-rate,reintubation rate and mortality after one year were compared. Results The readmission rate,reintubation rate and mortality of B group lowered 38.4%, 17.3 % and 18.0% respectively, compared to A group. While, the readmission rate, reintubation rate and mortality of C group lowered 8.0% ,35.3% and 29.4% respectively,compared to B group. There was significant discrepancy in readmission rate, reintubation rate and mortality among the three groups （P 〈 0.05 ）. Conclusion Long-term domiciliary oxygen therapy and long-term domiciliary NPPV can lower readmission rate,reintubation rate and mortality of patient with COPD at advanced stage. Long-term domiciliary oxygen therapy plus long-term domiciliary NPPV is the best therapy.