BiPAP无创治疗重度-极重度COPD稳定期患者短期疗效观察

Short-term efficacy of noninvasive Bi-level positive airway pressure in severe/very severe COPD patients with stable stage

目的观察无创双水平正压通气(BiPAP)治疗重度-极重度慢性阻塞性肺疾病(COPD)稳定期患者的短期疗效。方法选取50例重度-极重度COPD稳定期患者,其中对照组(25例)给予舒利迭吸入治疗,治疗组在对照组治疗基础上加用BiPAP无创通气治疗。分别于治疗前(0周)及治疗后1、4、12周检测肺活量(VC)、用力肺活量(FVC)、1秒用力呼气容积(FEV_1)、最大通气量(MVV)、最大中期呼气流速(MMF)的预计值及残气量/肺总量(RV/TLC)的实测值,并测定6min步行时间(6MWT)及经皮血氧饱和度(SpO_2),评价Borg呼吸困难程度(Borg指数),观察12周内两组急性加重的患者数。结果与0周比较,治疗组治疗后1、4、12周6MWT、Borg指数及SpO_2均发生显著变化(均P<0 01);与对照组同时点比较,治疗组治疗后1、4、12周6MWT、Borg指数及SpO_2均发生显著变化。与0周比较.对照组仅治疗后1、4周FEV_1明显升高,治疗组治疗后1周FVC、FEV_1、MVV均发生明显变化,治疗后4、12周各指标均发生明显变化,差异均有统计学意义(P<0.05或0.01);与对照组同时点比较,治疗组治疗后1周MVV显著升高,治疗后4、12周FEV_1、MVV、MMF、RV/TLC均发生明显变化,差异均有统计学意义(P<0,05或0.01)。治疗期间.治疗组急性加重发生率明显低于对照组(8.0%、36.0%),差异有统计学意义(P<0.05)。结论常规治疗基础上辅以BiPAP更能在短期内改善重度-极重度COPD稳定期患者的肺通气功能,增进氧合。提高活动能力。减少急性发作。

Objective To observe the short- term efficacy of noninvasive Bi- level positive airway pressure （BiPAP） in se-vere/very severe patients with chronic obstructive pulmonary disease （COPD） of stable stage. Methods Fifty severe/very severe COPD patients at stable stage were divided into two groups. The control group （25 cases） were given Seretide inhalation therapy, and the treatment group （25 cases） were given Seretide inhalation combined with BiPAP noninvasive ventilation. Lung capacity （VC）, forced vital capacity （FVC）, the 1st second forced expiratory volume （FEV1）, maximum voluntary ventilation （MVV）, maximum mid- expiratory flow （MMF） and the estimated value of the residual volume/total lung capacity （RV/TLC） , 6min walking time （6MWT） and oxygen saturation （SpO2） were measured. Borg dyspnea （Borg index） was evaluated before and 1, 4, 12 weeks after treatment. The incidence of acute exacerbation in 12 weeks were also observed. Results Compared with before treatment, the 6MWT, Borg index and SpO2 in treatment group were significantly improved at 1, 4 and weeks after treatment （P＆lt;0.01）. Com-pared with control group, the 6MWT, Borg index and SpO2 in treatment groups were more markedly improved at each time points. FEV1 in control group was significantly enhanced at 1, 4 weeks after treatment. FVC, FEV1 and MVV were al improved significantly in treatment group at 1 week after treatment and the remaining indicators were significantly improved at 4 and 12 weeks after treatment （P＆lt;0.05 or P＆lt;0.01）. Compared with control group, MVV at 1 week after treatment, FEV1, MVV, MMF and RV/TLC in treatment group at 4 and 12 weeks after treatment were al significantly increased （P＆lt;0.05 or P＆lt;0.01）. The incidence of acute exacerbation was significantly lower in treatment group than that in control group （8.0%vs 36.0%, P＆lt;0.05）. Conclusion BiPAP noninvasive ventilation combined with Seretide inhalation can improve the pulmonary ventilation function, promote oxygenation, elevate exercise tolerance and decrease acute exacerbation in severe- very severe COPD patients at stable stage in short- term.