家庭双水平无创正压机械通气对稳定期极重度COPD患者的疗效观察

Curative effects of home bi-level non-invasive positive airway pressure ventilation in the treatment of patients with severe chronic obstructive pulmonary disease of stable phase

目的:观察双水平气道正压通气(BIPAP)在极重度慢性阻塞性肺疾病(COPD)患者稳定期康复治疗中的疗效。方法:将42例极重度COPD稳定期患者随机分为两组,对照组(21例)采用单纯家庭氧疗,治疗组(21例)采用BIPAP治疗,两组均治疗2年。在治疗期间所有入选患者均被要求戒烟,行缩唇呼吸或腹式呼吸等肺康复锻炼,必要时给予化痰治疗。分析患者治疗前及治疗2年后的动脉血气、肺通气功能、6 min步行距离、年住院率的变化。结果:治疗前治疗组与对照组的动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、每年住院次数、第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、6 min步行距离差异均无统计学意义(t=0.886、-0.666、2.630、-0.024、0.095、0.635,均P>0.05);治疗2年后治疗组死亡4例(4/21),对照组死亡6例(6/21),两组比较差异无统计学意义(P>0 05);治疗2年后治疗组PaCO2、PaO2、每年住院次数、FEV1、FVC及6 min步行距离与对照组比较,差异均有统计学意义(t=-16.857、5.752、-16.053、2.684、3.338、7.644,均P<0.05)。结论:双水平气道正压无创通气可降低稳定期极重度COPD患者的PaCO2及年住院率,疗效优于单纯氧疗,从而提高稳定期COPD患者的生活质量,达到较好的长期治疗效果。

Objective： To observe the curative effects of bi-level non-invasive positive airway pressure（BIPAP） ventilation in the rehabilitation treatment of patients with severe chronic obstructive pulmonary disease（COPD） of the stable phase.Methods： 42 cases of patients with severe stable phase COPD were randomly divided into 2 groups.The control group was received simple home oxygen therapy,while the treatment group was received BIPAP treatment for 2 years.During the treatment period,all selected patients were required to quit smoking,do pursed-lip breathing or abdominal breathing and other pulmonary rehabilitation exercise,and were received phlegm removing treatment if necessary.The changes of arterial blood gases,lung function,6-minute walk distance and annual hospitalization rate before treatment and 2 years after treatment were analyzed.Results： Before treatment,the arterial partial pressure of carbon dioxide（PaCO2）,arterial partial pressure of oxygen（PaO2）,annual hospitalization times,first second forced expiratory volume（FEV1）,forced vital capacity（FVC） and 6-minute walk distance（6MWD） were compared between the treatment group and the control group,the differences were not statistically significant（t=0.886,-0.666,2.63,-0.024,0.095 and 0.635 respectively,all P0.05）.Two years after treatment,the treatment group had 4 cases of death（4/21） and the control group had 6 cases of death（6/21）,there was no statistically significant difference（P0 05）.Two years after treatment,the PaCO2,PaO2,annual hospitalization times,FEV1,FVC and 6MWD were compared between the two groups,the differences were statistically significant（t=-16.857,5.752,-16.053,2.684,3.338 and 7.644 respectively,all P0.05）.Conclusion： The BIPAP ventilation can reduce the partial pressure of PaCO2 and the annual hospitalization rate of patients with severe COPD of stable phase and has curative effects superior to the simple oxygen therapy,and thus improve the life quality of patients with stable phase COPD and achieve better long-term curative effects.