家庭无创机械通气治疗稳定期重度慢性阻塞性肺疾病的疗效观察

Effect of Long Term Home-used Non-invasive Positive Pressure Ventilation in Patients with Stable Severe Chronic Obstructive Pulmonary Disease

【目的】评估长期家庭无创正压机械通气治疗稳定期重度慢性阻塞性肺疾病（COPD）患者的疗效。【方法】31例重度COPD稳定期患者随机分为对照组（16例，常规治疗）和观察组（15例，长期家庭无创正压机械通气＋常规治疗）。治疗后随访1年，比较两组患者的血气分析、肺功能、6分钟步行距离（6MWD）、改良版英国医学研究会呼吸困难量表（mMRC）评分、圣乔治评分、睡眠时间等指标。【结果】两组患者治疗1年期间均无死亡病例或其他原因退出病例。两组患者治疗前动脉血氧分压（PaOz）、一秒用力呼气容积（FEVl）、一秒用力呼气容积（FEVl）／用力肺活量（FVC）、动脉血二氧化碳分压（PaC02）、6MWD、mMRC评分、圣乔治评分、睡眠时间比较差异均无统计学意义（P〉0．05）；观察组患者治疗后PaCO2及圣乔治评分均下降，与对照组比较，差异均有统计学意义（P〈0．05）；而两组患者Pa02、FEVl（L）、FEVl／FVC（％）、6MWD、MRC评分、睡眠时间比较差异均无统计学意义（P〉O．05）。【结论]家庭无创通气治疗可改善重度COPD患者呼吸衰竭和生活质量，对于稳定期重度COPD患者是一种有效的治疗手段，值得临床推广应用。

[Objective]To evaluate the efficacy of long-term non invasive positive pressure mechanical ven- tilation in the treatment of stable severe chronic obstructive pulmonary disease（COPD）.[Methods]Thirty-one patients with severe stable COPD were randomly divided into control group （ n = 16） and observation group （ n = 15）, The patients were followed up for 1 year after treatment. The blood gas analysis , the lung function, 6 minutes walking distance （6MW DX）, the modified British Medical Research Society dyspnea scale （mMRC）, St. George＇s score and sleep time of the two groups were compared.[Results]There were no cases of death or withdrawal from other causes during one year of treatment in both groups.Of the two groups of pa tients before treatment, there was no significant difference in PaOe, FEV1, FEV1/FVC, PaCO2 , 6MWD, mMRC score,St George＇s score and sleep time （ P 〉0.05） . The scores of PaCOz and St. George in the obser- vation group were decreased after treatment, and the difference was statistically significant compared wi＇ch the control group （ P 〈0.05 ）. However, there was no significant difference in PaO2, FEVI （ L）, FEV1/FVC（ % ）, 6MWD,MRC score and sleep duration between the two groups （ P〉0.05）. [Conclusion]Home-used noninva- sive ventilation therapy can improve respiratory failure and quality of life in patients with severe COPD. It is an effective treatment for stable severe COPD patients and is worthy of clinical application.