无创正压通气对慢性阻塞性肺疾病合并慢性呼吸衰竭患者肺康复的效果

Effect of noninvasive positive pressure ventilation on pulmonary function in patients with chronic obstructive pulmonary disease complicated with chronic respiratory failure

目的探讨无创正压通气对慢性阻塞性肺疾病（COPD）合并慢性呼吸衰竭患者肺康复的效果。方法选择2013年4月至2014年4月山西省大同市第三人民医院收治的COPD合并慢性呼吸衰竭患者60例，按照随机数字表法分成观察组和对照组，各30例。对照组采用常规临床治疗、健康教育、运动训练。观察组在对照组基础上给予无创正压通气治疗。比较2组治疗前和治疗1个月后6min步行距离、Borg呼吸困难评分、第1秒用力呼气容积／用力肺活量（FEV1／FVC）、生存质量评估（QOL）评分、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）。结果治疗后，观察组6min步行距离明显高于治疗前和对照组治疗后[（425±31）m比（256±38）、（337±33）m]，Borg呼吸困难评分明显低于治疗前和对照组治疗后[（6．0±1．5）分比（8．0±1．3）、（7．1±1．5）分]，差异均有统计学意义（均P〈0．05）。观察组治疗后QOL评分明显低于治疗前[（96±8）分比（122±13）分]，差异有统计学意义（P〈0．05）。2组患者治疗前后FEV1／FVC、PaO2、PaCO2比较，差异均无统计学意义（均P〉0．05）。结论采用无创正压通气对COPD合并慢性呼吸衰竭患者进行肺康复训练，能明显改善呼吸困难症状，提高运动耐力和生存质量，稳定患者的肺功能，改善患者的预后。

Objective To explore the effect of noninvasive positive pressure ventilation （NIPPV） on pulmonary in patients with chronic obstructive pulmonary disease （COPD） combined with chronic respiratory failure. Methods Totally 60 patients with COPD complicated with chronic pulmonary failure from April 2013 to April 2014 were enrolled and randomly divided into observation group and control group （30 cases in each group）.Both groups experienced regular clinical therapy, health education and exercise training; observation group was additionally given NIPPV treatment. The 6 min walking distance, Brog dyspnea score, ratio of FEVl and forced vital capacity in percentage （ FEVt/FVC% ） , quality of life （QOL） , arterial partial pressure of oxygen （ PaO2 ） and arterial partial pressure of carbon dioxide （ PaCO2 ） before and 1 month after treatment were compared between groups. Results One month after treatment, the 6 min walking distance was significantly longer and the Borg dyspnea score was significantly lower in observation group than those before treatment and control group [ （425 ± 31） mvs （256±38）, （337 ±33） m; （6.0 ±1.5） scoresvs （8.0±1.3）, （7.1 ±1.5） scores] （P〈0.05）; the QOL score in observation group was significantly improved after treatment compared with that before treatment [ （96±8）scores vs （122- 13 ）scores] （P 〈 0.05 ）. The FEVI/FV, PaO2 and PaCO2 were not significantly changed after treatment in both groups （ P 〉 0.05 ）. Conclusions NIPPV treatment can improve the dyspnea symptom, enhance the excise tolerance and life quality, stabilize the lung function, improve the prognosis in patients of COPD complicated with chronic pulmonary failure.