门诊不同压力无创正压通气对慢性阻塞性肺疾病稳定期合并Ⅱ型呼吸衰竭肺康复影响研究

Effects of long-term different-intensity noninvasive ventilation on pulmony rehabilitation of outpatients with stable chronic obstructive pulmonary disease complicated by type Ⅱ respitatory failure

目的探讨长期门诊不同压力无创正压通气对慢性阻塞性肺疾病（慢阻肺）稳定期合并Ⅱ型呼吸衰竭患者肺康复的影响。方法将2011年10月至2014年10月广东药学院附属第一医院呼吸内科118例慢阻肺稳定期合并Ⅱ型呼吸衰竭患者随机分为两组，其中高压通气组58例，设置吸气压力水平（IPAP）为1．76～2．94kPa；低压通气组60例，IPAP为0．98～1．76kPa。两组患者在门诊接受．g44正压通气治疗1年。比较两组患者治疗1年前后的血气分析、肺功能、呼吸困难症状、运动能力、生活质量、急性加重住院次数、平均住院时间、平均住院费用以及生存率等指标变化。结果高压通气组与低压通气组相比，动脉血二氧化碳分压（PaCO2）、氧分压（PaO2）、改良英国医学研究委员会呼吸困难量表（mMRC）评分、圣乔治呼吸问卷评分（SGRQ）、第一秒用力呼吸容积占预计值百分比（FEV1％）、用力肺活量（FVC）均显著改善（P〈0．05）。1年内急性加重住院次数、平均住院时间和平均住院费用均显著下降（P〈0．05）。两组患者6min步行距离（6MWD）、FEV，／FVC差异无统计学意义。两组患者生存率比较差异无统计学意义（91．4％对86．6％，P=0．414）。结论慢阻肺稳定期合并Ⅱ型呼吸衰竭患者门诊长期应用高压力无创正压通气可显著改善患者肺功能、纠正二氧化碳潴留，提高患者生活质量，减少呼吸困难症状、急性加重住院次数和平均住院费用，是一种有效的肺康复手段。

Objective To explore the effects of long-term different-intensity noninvasive ventilation on patients with stable chronic obstructive pulmonary disease（COPD） complicated by type 1I respitatory failure. Methods Totally 118 patients with stable COPD were divided randomly into two groups： high-intensity group （1PAP 1.76-2.94 kPa, n=58） and low-intensity group （IPAP 0.98-1.76 kPa, n=60）. All patients received noninvasive ventilation for at least one year. Gas exchange, pulmonary function, dyspnea, exercise tolerance, health-related quality of life, hospital admissions, hospital stay average hospital cost and survival rate were compared between two groups before and after the treatment. Results Compared with low-intensity group, high-intensity group showed an significant improvement in gas exchange, mMKC, SGKQ, hospital admissions, hospital stay and average hospital cost （P〈0.05）. No significant differences in sixminute walking distance and FEV1/FVC were found between the two groups （P〉0.05）. Survivalwas similar in both groups （91.4% vs 86.6% P=0.414）. Conclusion Long-term high-intensity noninvasive ventilation for patients with stable COPD may exert preferable potential in improving pulmonary function, carbon dioxide retention and health-related quality of life and dyspnea, as well as reducing hospitalisations and average hospital cost, so it is effective in pulmonary rehabilitation.