夜间无创正压通气对重度-极重度慢性阻塞性肺疾病相关肺动脉高压的影响

Influence of nocturnal non-invasive positive pressure ventilation on severe and extremely severe chronic obstructive pulmonary disease associated pulmonary arterial hypertension

目的评估夜间无创正压通气对重度-极重度慢性阻塞性肺疾病(COPD)相关肺动脉高压患者肺动脉压力的影响,并寻找改善COPD合并肺动脉高压患者预后的可行方法。方法 42例COPD合并肺动脉高压患者,分为无创正压通气组(14例)和对照组(28例)。对照组给予长期家庭氧疗和常规药物治疗,无创正压通气组在对照组基础上给予夜间无创正压通气治疗,并选择合适无创正压通气参数,观察两组患者血气分析、肺动脉压力及脑钠肽水平的改变。结果无创正压通气组患者中观察期间死亡1例(7.14%);对照组患者在观察期间死亡2例(7.14%),两组死亡率比较差异无统计学意义(P>0.05)。排除死亡病例,两组患者治疗后不同时间的pH、动脉氧分压(PaO_2)、动脉二氧化碳分压(PaCO_2)、血清氨基末端脑钠肽前体(NT-proBNP)、肺动脉收缩压(PASP)水平均优于治疗前,且无创正压通气组患者治疗后不同时间的p H、PaO_2、PaCO_2、NT-pro BNP、PASP水平均优于对照组同期指标,差异均有统计学意义(P<0.05)。结论对于重度-极重度COPD合并肺动脉高压患者,在长期氧疗及使用吸入糖皮质激素联合长效β2受体激动剂(ICS/LABA)基础上,夜间无创通气可改善夜间低氧血症、缓解二氧化碳潴留并纠正呼吸性酸中毒,从而降低肺动脉压力。

Objective To evaluate influence of nocturnal non-invasive positive pressure ventilation on severe and extremely severe chronic obstructive pulmonary disease（COPD） associated pulmonary arterial hypertension, and explore feasible method to improve prognosis of patients with COPD and pulmonary arterial hypertension. Methods A total 42 patients with COPD and pulmonary arterial hypertension were divided into non-invasive ventilation group（14 cases） and control group（28 cases）. The control group received long-term domiciliary oxygen therapy and conventional drugs, and the non-invasive ventilation group received nocturnal non-invasive positive pressure ventilation with suitable noninvasive positive pressure ventilation parameters on the basis of the control group. Observation were made on changes of blood gas analysis, pulmonary arterial pressure and brain natriuretic peptide in two groups. Results The non-invasive ventilation group had 1 dead case during observation period（7.14%）, and the control group had 2 dead cases during observation period（7.14%）. There was no statistical significant difference of mortdity in two groups（P〉0.05）. Both groups had better p H, arterial partial pressure of oxygen（PaO2）, arterial partial pressure of carbon dioxide（PaCO2）, N-terminal pronatriuretic peptide（NT-pro BNP） and pulmonary arterial systolic pressure（PASP） in different period after treatment than before treatment, and the non-invasive ventilation group had better pH, PaO2, PaCO2, NT-pro BNP and PASP in different period after treatment than the control group of corresponding period, and differences had statistical significance（P〈0.05）. Conclusion For patients with severe and extremely severe COPD and pulmonary arterial hypertension, non-invasive positive pressure ventilation can improve nocturnal hyoxemia, relieve carbon dioxide retention and correct respiratory acidosis to reduce pulmonary arterial pressure, on the basis of long term oxygen therapy and inhaled corticosteroids and long-effect β2 reactant excitomotor agent（ICS/LABA）.