无创通气对于合并Ⅱ型呼吸衰竭的慢阻肺稳定期患者的疗效观察

Efficacy of noninvasive ventilation in patients with chronic obstructive pulmonary disease combined with type Ⅱ respiratory failure

目的观察家庭用无创正压通气对于合并慢性呼吸衰竭稳定期COPD患者的临床疗效。方法选择研究对象为2014年12月-2016年12月因AECO PD合并呼吸衰竭于成都市第二人民医院呼吸科住院患者,通过无创通气治疗后处于稳定期,但出院时仍存在II型呼吸衰竭者,共58例。根据患者是否使用家庭无创呼吸机分为2组,实行家庭无创通气患者为治疗组,共26例,家庭氧疗患者为对照组,共32例,其中治疗组男性患者18例,女性患者8例,对照组男性患者21例,女性患者11例,通过观察两组1年内住院次数,CAT评分,肺功能变化(FEV1、FVC)进行对比分析。所有入组患者均符合慢阻肺诊治指南标准。排除标准:(1)合并支气管扩张、肺结核、肺间质纤维化、矽肺等慢性肺部疾病患者。(2)合并严重肺大泡及曾经发生过气胸的患者。(3)合并严重心功能不全、严重心律失常、严重贫血患者。结果 (1)对于治疗组及对照组患者进行基线比较差异无统计学意义。(2)治疗组1年内住院次数、CAT评分较前比较有明显减少,差异有统计学意义;对照组1年内住院次数、CAT评分较前比较无明显减少,差异无统计学意义。治疗组较对照组1年内住院次数、CAT评分比较明显减少,差异具有统计学意义。(3)对于治疗组及对照组治疗前后肺功能观察,治疗组治疗1年后FEV1、FVC改善无统计学意义,对照组亦无统计学意义。结论对于合并慢性呼吸衰竭的COPD稳定期患者长期使用家庭无创正压通气可以显著改善生活质量、减少住院次数,但不能有效改善患者肺功能。

Objective To observe the clinical efficacy of noninvasive positive pressure ventilation in patients with Stable COPD combined with respiratory failure.Methods Patients having AECOPD combined with respiratory failure and being hospitalized at respiratory department of the Second People＇s Hospital in Chengdu from December 2014 to December 2016 were selected as study objects.All cases were given noninvasive ventilation in a stable period,but there were still 58 cases having type II respiratory failure.According to whether the patients were carried out the noninvasive ventilator,all cases were divided into two groups.Patients with nonlnvasive ventilation were enrolled in the treatment group with a total of 26 cases,while 32 patients being given home oxygen therapy were being as the control group.,In the treatment group,there were 18 cases of male patients and 8 cases of female patients.In the control gro.up,there were 21 cases of male patients and 11 eases of female patients.Hospitalizations days,CAT score and FEV1 and FVC were compared between two groups.All patients met the standard for COPD treatment guidelines.Exclusion criteria：（1）combined with bronchiectasis,tuberculosis,pulmonary interstitial fibrosis,silicosis and other chronic lung disease patients.（2）patients with severe pulmonary bullae and who had had pneumothorax.（3）cases combined with severe cardiac insufficiency,severe arrhythmia,severe anemia.Results（1）There was no significant difference in baseline between the treatment group and the control group.（2）The number of hospitalizations and CAT scores in the treatment group decreased significantly compared with that at the previous year,the difference was statistically significant;There was no significant difference in CAT score before and after treatment in the control group（P 〈0.05）;The number of hospitalizations and CAT scores in the treatment group were significantly lower than those in the control group,and the difference was statistically significant.Conclusion Long-term use of noninvasive positive ventilation in patients who have COPD combined with chronic respiratory failure can significantly improve the quality of life and reduce the number of hospitalizations,but it cannot effectively improve the patient＇s lung function.