长期家庭无创辅助通气对稳定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的疗效分析

Efficacy analysis of long-term home non-invasive assisted ventilation in stable chronic obstructive pulmonary disease combined with type Ⅱrespiratory failure

目的探讨长期家庭无创辅助通气对稳定期慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭患者的治疗效果。方法确诊稳定期COPD合并Ⅱ型呼吸衰竭患者共78例，按患者意愿分为治疗组26例和对照组52例，对照组予以常规治疗，包括吸入沙美特罗，氟替卡松＋长期家庭氧疗（LTOT）；治疗组在常规治疗基础上加用无创辅助通气治疗，每日6～8h，疗程12个月，观察两组血气分析指标[pH值、动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）]、肺功能指标[第1秒用力呼气容积（FEV1）、FEV1占预计值百分比（FEv1％）]、6main步行试验（6．MwT）距离、圣乔治呼吸问卷（SGRQ）iS分及急性发作住院次数。结果随访12个月，治疗组无一例因急性发作行气管插管，无一例死亡。对照组有5例因急性发作行气管插管、有创机械通气，其中1例死亡。治疗后两组肺功能指标（FEV1、FEV1％）较治疗前均有改善（P〈0．05）。但治疗组治疗后FEV1、FEV1％显著高于同期对照组（P〈0．05）。治疗组治疗后血气分析指标（pH值、PaCO2、PaO2）较治疗前显著改善（P〈0．05）。对照组治疗后PaO2较治疗前显著改善（P〈0．05），但对照组治疗后pH值、PaCO2与治疗前比较差异无统计学意义（P〉0．05）。两组患者治疗后6-MWT距离、SGRQ评分较治疗前均有改善，差异有统计学意义（P〈0．05），治疗组治疗后6-MWT距离显著高于同期对照组、SGRQ评分显著低于同期对照组，差异均有统计学意义（P〈0．05）。随访12个月，治疗组平均每人急性发作次数（0．84±0．16）次，对照组（1．49±0．78）次，差异有统计学意义（t=-3．65，P〈0．05）。结论家庭无创辅助通气治疗可以改善稳定期COPD合并Ⅱ型呼吸衰竭患者的肺功能、血气分析，增加运动耐量，提高生活质量，减少急性发作次数及插管率。

Objective To investigate the clinical effect of long-term home non-invasive assisted ventilation in stable chronic obstructive pulmonary disease COPD combined with type Ⅱ respiratory failure. Methods Seventy-eight patients with stable COPD combined with type Ⅱ respiratory failure were divided into treatment group （26 cases） and control group （52 cases）. Patients in control group were given conventional treatment,including inhaled salmeterol/fluticasone plus long-term home oxygen therapy （LTOT）. Patients in treatment group on the basis of conventional treatment were given non-invasive assisted ventilation therapy for 6 -8 hours a day,and the course was 12 months. Blood gas analysis index [pH,arterial blood carbon dioxide partial pressure （PaCO2）, arterial blood oxygen partial pressure （PaO2）], pulmonary function index [ forced expiratory volume in 1 second （FEV1）, FEV1 percentage of expected value （FEV1%） ], 6 min walk test （6-MWT） distance, St George＇ s respiratory questionnaire （SGRQ） and acute episodes. Results After 12 months＇follow-up, there was no endotracheal intubation and dead patients in treatment group. Five patients had acute trachea intubation and invasive mechanical ventilation, and 1 case died in the control group. The index of pulmonary function （FEV1, FEV1% ） in two groups after treatment was improved compared with that before treatment （P〈 0.05）. But FEV1 and FEVI% over the same period in treatment group after treatment was higher than that in control group （P 〈 0.05）. The blood gas analysis indicators （pH, PaCO2, PaO2） in treatment group after treatment were improved compared with that before treatment （P 〈0.05）. PaO2 in control group after treatment was improved,compared with that before treatment （P〈 0.05 ）, but there was no significant difference in control group in pH and PaCO2 levels before and after treatment （P 〉0.05）. After treatment 6-MWT distance, and SGRQ scores were improved, compared with that before treatment （P 〈0.05）, 6-MWT from the same period in treatment group after treatment was higher than that in control group, and SGRQ scores was lower than that in control group during this period （P 〈 0.05 ）. There was significant difference in average acute episodes between treatment group and control group [（0.84±0.16） times vs. （1.49±0.78） times, t =-3.65,P〈0.05]. Conclusion Home non-invasive assisted ventilation treatment can improve blood gas analysis and pulmonary function in patients of COPD combined with type Ⅱ respiratory failure of stationary phase, increase exercise tolerance, improve the quality of life, and reduce the number of acute episodes and intubation rate.