慢性阻塞性肺疾病并呼吸衰竭患者的家庭机械通气治疗现状调查

One Year's Follow-up of Home Mechanical Ventilation for Stable Chronic Obstructive Pulmonary Disease Patients with Respiratory Failure

目的了解北京市通州区慢性阻塞性肺疾病(简称慢阻肺)伴呼吸衰竭患者家庭机械通气(HMV)的治疗效果。方法纳入北京市通州区家庭拥有双水平无创呼吸机和制氧机进行HMV治疗的慢阻肺并呼吸衰竭患者共20例,其中4例在随访期间去世,1例失访,共15例完成随访。在随访开始和1年结束时收集患者一般资料,测定实际体重等营养状况,测试慢阻肺评估、Borg呼吸困难和呼吸疲劳评分、Hamilton抑郁量表评分和Hamilton焦虑量表评分,行动脉血气分析。随访期间每月进行1次电话随访。结果与随访开始时比较,在1年随访结束时实际体重等营养状况指标、慢阻肺评估测试、Borg呼吸困难和呼吸疲劳评分、Hamilton抑郁量表评分和Hamilton焦虑量表评分以及p H和Pa O2无显著差别(P>0.05),Pa CO2显著降低(P<0.05)。随访年度同随访前1年比较,患者因慢阻肺急性加重的住院次数显著减少(P<0.05)。结论 HMV治疗和对HMV患者进行随访管理可显著降低慢阻肺并呼吸衰竭患者的二氧化碳水平,减少患者因慢阻肺急性加重导致的住院次数。

Objective To evaluate the effects of home mechanical ventilation（ HMV） for stable chronic obstructive pulmonary disease（ COPD） patients with respiratory failure in Tongzhou district of Beijing city. Methods Twenty stable COPD patients with respiratory failure were included in the study.During the one-year follow-up period,4 patients died and 1 withdrew and 15 patients finished the follow-up.The patients was followed up by telephone each month and guided in drug administration,HMV,and rehabilitation therapy. At the beginning of the study and one year later,the patients were interviewed and accessed on the general data,nutritional status,COPD assessment test（ CAT）,Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,and arterial blood gas analysis. Results At the end of one-year follow-up,nutrition index,CAT,Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,p H,and Pa O2 did not change significantly（ P 〉 0. 05）,while Pa CO2 decreased significantly compared with those at the beginning of the study（ P 〈 0. 05）. Compared with the past year,the times of hospitalization due to acute exacerbation of COPD was significantly reduced during the follow-up year（ P 〈 0. 05）. Conclusions HMV can ameliorate carbon dioxide retention and reduce times of hospitalization due to acute exacerbation of COPD for COPD patients with respiratory failure.