无创通气对慢阻肺合并肺动脉高压患者生活质量影响分析

Effect of noninvasive ventilation on quality of life in patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension

目的评估夜间无创通气对COPD所致肺动脉高压患者的影响,并寻找改善COPD合并肺动脉高压患者预后的可行方法。方法选择2014年12月~2016年12月于我院住院及门诊随诊的42例重度-极重度COPD合并肺动脉高压患者作为研究对象,在征得本院伦理委员会批准及患者知情同意下采用等距随机抽样法分为对照组28例(家庭氧疗)及研究组14例(经面罩双水平正压通气治疗)对两组肺动脉压力、肺通气功能、6分钟步行距离(6MWD)、CAT评分进行比较。结果长期夜间无创通气可降低慢阻肺合并肺动脉高压患者肺动脉压力、延缓FEV1下降,治疗后CAT评分研究组低于对照组,6MWD高于对照组,差异有统计学意义(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-长效支气管舒张剂基础上,无创通气可缓解FEV1和运动耐力下降,改善或者生活质量。

Objective To evaluate the effect of noninvasive ventilation on COPD-induced pulmonary hypertension,and to find a feasible method to improve the prognosis of COPD patients with pulmonary hypertension. Methods 42 patients with severe-severe COPD complicated with pulmonary hypertension cured in our hospital from December 2014 to December 2016 were selected as the subjects.Under the approval of the ethics committee and the patient＇ s informed consent,the patients were divided into control group （n=28,treated with home oxygen therapy） and study group （n=14,treated with mask bi level positive airway pressure）.The pulmonary arterial pressure,pulmonary ventilation function,6 minutes walking distance （6MWD） and CAT scores of the two groups were compared. Results Long-term noninvasive ventilation at night could reduce the pulmonary artery pressure and delay FEV1 in patients with COPD complicated with pulmonary hypertension.There was a significant difference between the two groups after CAT score and 6-minute walking distance （6MWD） （P 〈 0.05）. Conclusion Noninvasive ventilation relieves FEV1 and decreases exercise tolerance in patients with severe-severe COPD complicated with pulmonary hypertension,with long-term oxygen therapy and inhaled glucocorticoid- long-acting bronchodilator.