无创正压通气联合噻托溴铵治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床分析

The clinical analysis of noninvasive positive pressure ventilation combined with totropium in treatment with chronic obstructive pulmonary desease complicated type Ⅱ respiratory failure

目的:观察无创正压通气联合噻托溴铵治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床效果。方法:2007年12月～2010年12月,112例COPD合并Ⅱ型呼吸衰竭患者随机分为两组,观察组56例采用无创正压通气联合噻托溴铵治疗,对照组56例采用异丙托溴铵气雾剂治疗,比较观察两组的呼吸困难、肺功能以及运动耐力变化。结果:与治疗前比较,观察组治疗后4周、12周呼吸困难评分明显下降(P<0.05),而对照组仅治疗后12周呼吸困难评分明显下降(P<0.05)。观察组治疗后4周、12周呼吸困难评分均明显低于同期对照组水平(P<0.05)。观察组治疗后FEV1、FVC和FEV1/FVC均较治疗前明显升高(P<0.05),而对照组无明显变化(P>0.05);观察组治疗后FEV1、FVC和FEV1/FVC均明显高于同期对照组水平(P<0.05)。两组治疗后6min步行距离均明显长于治疗前(P<0.05);观察组治疗后6min步行距离明显长于同期对照组(P<0.05)。结论:无创正压通气联合噻托溴铵治疗COPD合并Ⅱ型呼吸衰竭,能够明显改善患者的临床症状,改善肺功能状态,提高运动耐力,值得在临床推广应用。

Objective：To observe the effect of noninvasive positive pressure ventilation combined with totropium in treatment with chronic obstructive pulmonary diseases （COPD）complicated type Ⅱ respiratory failure. Methods：From December 2007 to December 2010, 112 cases with COPD complicated type Ⅱ respiratory failure were randomly classified into two groups, which observation group with 56 cases were treated with noninvasive positive pressure ventilation combined with totropium and control group with 56 cases were treated with ipratropium bromide aerosol. The changes of breathing difficulties, lung function and exercise tolerance between two groups were compared. Results：Compared with pretreatment, the breathing difficulties scores in observation group after treatment 4 weeks and 12 weeks were significantly decreased（P0.05）, while the scores in control group only after treatment 12 weeks were significantly decreased（P0.05）. The breathing difficulties scores in observation group after treatment 4 weeks and 12 weeks were significantly lower than those in control group（P0.05）. Compared with pretreatment, the levels of FEV1, FVC and FEV1/ FVC in observation group after treatment were significantly increased（P0.05）, while no significant difference in control group （P0.05）. The levels of FEV1, FVC and FEV1/ FVC in observation group after treatment were significantly higher than those in control group（P0.05）.Compared with pretreatment, the 6 min walking distance in both two groups after treatment were significantly extended（P0.05）. The 6 min walking distance in observation group after treatment was significantly longer than that in control group（P0.05）. Conclusion：Noninvasive positive pressure ventilation combined with totropium in treatment with COPD complicated type Ⅱ respiratory failure can improve clinical symptom and lung function, enhance exercise tolerance, which can be applied in clinic.