Bi-PAP治疗重叠综合征合并呼吸衰竭患者远期预后研究

Long-term prognosis of Bi-PAP therapy for overlap syndrome patients with respiratory failure

目的 探讨双水平气道正压通气（Bi-PAP）治疗重叠综合征合并呼吸衰竭患者的远期疗效.方法 选取2009年6月至2010年12月我院收治的38例重叠综合征合并呼吸衰竭的患者,将患者随机分为观察组（n=20）和对照组（n=18）.对照组采用常规治疗,观察组加用Bi-PAP治疗.分别于治疗后第1年、第2年以及第3年内进行随访,观察记录每年患者急性加重住院的次数及生存率.并于治疗后第3年对患者的血气指标、肺功能等进行监测.结果 观察组患者随访3年时在睡眠呼吸暂停低通气指数、最低血氧饱和度、Epworth评分、pH值、PaO2、PaCO2以及FEV1％ pred等方面均显著优于对照组;2组患者急性加重住院次数均逐年递减,但同时期2组相比较,观察组急性加重住院次数明显低于对照组;在随访第2年及第3年,观察组患者的生存率明显高于对照组,其中,尤以第3年差异最为显著,观察组生存率为65.00％,明显高于对照组（33.33％,x2=9.619,P=0.000）.结论 Bi-PAP治疗重叠综合征伴呼吸衰竭患者能够有效地提高治疗效果,改善患者的血气指标及肺功能,延缓病情,降低患者的病死率.

Objective To investigate long-term prognosis of bi level positive airway pressure （Bi-PAP） therapy for overlap syndrome patients with respiratory failure.Methods 38 cases of overlap syndrome with respiratory failure from June 2009 to December 2010 in our hospital were selected,and were divided randomly into observation group （n =20） and control group （n =18）.The control group received conventional treatment,and the observation group received Bi-PAP treatment based on conventional treatment.The patients were followed up respectively in the first,second and third year after treatment,and the number of patients hospitalized for acute exacerbations and survival was recorded.In the third year after treatment,the blood gas and pulmonary function of patients were monitored.Results The apnea hypopnea index,lowest nocturnal oxygen saturation,Epworth sleepiness scale,p H value,PaO2,PaCO2,and FEV1% pred in the observation group were better than those in the control group in the third year after treatment.The times of hospitalization with acute exacerbations in two groups were diminishing,the observation group was significantly lower than the control group.The survival rate of observation group was significantly higher than that of the control group in the second and third year after treatment,especially in the third year the difference was the most significant （65.00% vs 33.33%,x2=9.619,P =0.000）.Conclusions Bi-PAP can effectively improve the therapeutic effect,improve the blood gas analysis and pulmonary function of patients,slow the disease and reduce mortality of overlap syndrome patients with respiratory failure.