家庭无创正压通气在重度慢性阻塞性肺疾病缓解期患者中的应用价值

Treatment effects of long term home non-invasive positive pressure ventilation in patients with stable serious chronic obstructive pulmonary disease

目的比较长期家庭无创正压通气与长期家庭氧疗治疗缓解期重度慢性阻塞性肺疾病患者的疗效。方法80例重度慢性阻塞性肺疾病缓解期患者分为无创正压机械通气治疗组（32例）和对照组（48例）。随访2年，比较2组患者病情恶化次数、住院时间及病死率、血气分析结果、肺功能及6分钟行走距离（6MWD）、观察治疗后患者症状（咳嗽、咯痰、气短等）。结果治疗2年后治疗组血气指标PaCO2、PaO2及6MWD较前改善，差异有统计学意义（P〈0．05）；2年内病情恶化次数及住院时间减少，差异有统计学意义（P〈0．05）；对照组以上指标均无改善，差异无统计学意义（P〉0．05）；两组肺功能指标FVC和FEV．均有下降，但治疗组下降更慢，差异有统计学意义（P〈0．05）；2年后两组以上参数比较差异均有统计学意义；2年后试验组死亡4例（4／32），对照组死亡8例（8／48），两组比较差异无统计学意义（P〉0．05）。结论重度慢性阻塞性肺疾病缓解期患者实施长期家庭无创正压机械通气可以明显减少病情恶化次数和住院时间，改善血气指标，减慢肺功能下降速度，提高生活质量。

Objective To determine the efficiency of long term home non invasive positive pressure ventilation （NIPPV） in patients with serious stable COPD. Methods Eighty patients with serious stable COPD were divided into treatment group （conventional treatment q-NIPPV, 32 patients） and control group （conventional treatment, 48 patients）. The lung function test, arterial blood gases, 6MWD, the rate of acute COPD exacerbations, hospital admissions and mortality were recorded before the treatment and two years after the treatment. Results PaCO2, PaO2 and 6MWD improved after two years in the treatment group （ P 〈0.05）,they did not improve in the control group （ P 〉0.05）. The frequencies of exacerbations and hospital admissions were decreased after two years in the treatment group （ P 〈0.05）, they were increased in the control group, but no significance. FVC and FEV1 were decreased after two years in two groups, but it was slow in the treatment group （ P 〈0.05）. All between the groups were statistically significant difference after two years. 4 cases in the treatment group and 8 cases in the control group were dead after 2 years, and the difference between the two groups was not significant （ P 〉0.05）. Conclusions Long term home NIPPV could decrease exacerbations and hospital admissions in patients with serious COPD who were in stable condition. This therapy may benefit blood gas tensions, the lung function and life quality in these patients.