无创通气治疗重度慢性阻塞性肺病并肺动脉高压的探讨

目的 探讨无创正压通气治疗老年稳定期重度慢性阻塞性肺疾病(COPD)并中重度肺动脉高压(PH)的疗效及安全性。方法 选择确诊为老年重度COPD并中重度PH患者35例,随机分两组;对照组(16例)常规综合治疗,治疗组(19例)常规综合治疗加社区无创通气(BiPAP)治疗,机械通气10h/d,疗程均为1a;观察治疗前后两组患者呼吸困难分级、PaO2、PaCO2、FEV1、FVC、MPAP、6MWT的变化。结果 治疗组治疗前后比较:治疗后呼吸困难分级、PaCO2、MPAP均明显降低,PaO2、6MWT均明显增加,差异均有统计学意义,P<0.05;治疗组治疗后与对照组治疗后比较:治疗组治疗后呼吸困难分级、PaCO2、MPAP明显低于对照组,PaO2、6MWT明显高于对照组,P<0.05;治疗组中重度PH患者治疗后比较:治疗后两组呼吸困难分级、PaO2、PaCO2比较,P>0.05,中度PH患者的MPAP低于重度PH,6MWT高于重度PH患者,以上差异均有统计学意义,P<0.05;治疗组与对照组、中重度PH患者治疗后FEV1、FVC均无明显改变。结论 无创通气是治疗老年稳定期重度COPD并中重度肺动脉高压的一种有效方法,依从性好,不良反应少。

Objective To discuss the effectiveness and security of NPPV in stationary phrase geratic patients with severe COPD and moderate to severe pulmonary hypertension （PH）. Methods Selected 35 cases which were diagnosed as severe geratic COPD and moderate to severe PH, and then randomly divided into two groups; control group （16 cases） was treated with conventional comprehensive treatment; treatment group （19 cases） was treated with NPPV 10 hours per day on the base of conventional comprehensive treatment. Course of treatment was one year. During the period, we observed the changes of dyspnea degree, Pad2, PaCO2, FEV~, FVC, MPAP and 6MWT. Results The comparison of before and after treatment in treatment group： dyspnea degree, PaCO2 and MPAP fell, while PaOz and 6MWT increased; differences were significant（P〈0.05）. Comparison between two groups after treatment： Dyspnea degree, PaCO2 and MPAP in treatment group were obviously lower than in the control group, Pad2 and 6MWT in treatment group were higher than in the control group; the difference between the two groups were significant（P〈0.05）. Comparison between moderate PH and severe PH in treatment group： There were no significant differences between the two subgroups in dyspnea degree, Pad2 and PaCOdP〉0.05）; in moderate PH group, MPAP was lower than in sever PH group, 6MWT was higher than in severe PH group, the differences between the two subgroups were significant（P〈0.05）. FEV and FVC didn＇t change significantly in both groups. Conclusion Noninvasive ventilation is an effective method in elderly stable severe COPD and moderate to severe pulmonary hypertension. It has only a few side-effects. The patients have good compliance.