高压力无创正压通气治疗慢性阻塞性肺疾病稳定期伴呼吸衰竭的疗效观察

Clinical observation of long-term high-intensity non-invasive positive pressure ventilation in the treatment of stable chronic obstructive pulmonary disease with respiratory failure

目的:探讨高压力无创正压通气治疗慢性阻塞性肺疾病(COPD)稳定期伴呼吸衰竭的临床疗效。方法:将2014年1月至2016年1月河北医科大学附属华北石油管理局总医院收治的COPD稳定期伴呼吸衰竭的50例患者,随机分为试验组(高压通气组,25例)与对照组(低压通气组,25例),吸气压力水平(IPAP)分别设置为1.76~2.74kPa、0.98~1.67kPa,比较治疗前、后的带机依从性、动脉血气分析、肺功能、6min步行距离(6MWD)、生活质量、急性加重次数及病死率。结果:与治疗前比较,两组治疗1年后动脉血氧分压(PaO2)、深吸气量占预计值百分比(IC%pred)、6MWD均明显升高,二氧化碳分压(PaCO2)、改良英国医学研究委员会呼吸困难问卷(mMRC)评分、CAT评分、年急性加重次数明显降低,差异均有统计学意义(均P<0.05);治疗1年后,试验组PaO2、IC%pred较对照组明显升高,PaCO2、mMRC评分、CAT评分较对照组显著降低,差异有统计学意义(P<0.05)。两组带机依从性、病死率和年急性加重次数比较,差异无统计学意义(P>0.05)。结论:长期高压力无创正压通气能更好地降低COPD稳定期伴呼吸衰竭患者的二氧化碳潴留,增加肺储备功能,提高运动耐力,改善生活质量。

Objective：To investigate the effects of long-term high-intensity non-invasive positive pressure ventilation（NIPPV）on patients with stable severe chronic obstructive pulmonary disease（COPD）.Methods：50 cases of stable COPD patients with respiratory failure treated in our hospital from January 2014 to2016 January were selected,and randomly assigned to a study group receiving high-intensity NIPPV with inspiratory positive airway pressure（IPAP）of 1.76-2.74 kPa,or a control group receiving low-intensity NIPPV with IPAP of 0.98-1.67 kPa.The compliance of non-invasive ventilator,blood gas analysis,pulmonary function,6-minute walking distance（6 MWD）,life quality,frequency of acute exacerbations during one year and mortality rate were compared between the two groups.Results：After treatment,the arterial partial pressure of oxygen（PaO2）,inspiratory capacity percentage of estimated value（IC% pred）and 6 MWD in both groups were increased（P 0.05）,while the PaCO2,modified British medical research council（mMRC）score,CAT score and frequency of acute exacerbations during one year were markedly decreased（P〈0.05）.The PaO2 and IC% pred were significantly higher in the study group than those in the control group（P〈0.05）,while the PaCO2,mMRC score and CAT score were lower（P〈0.05）.There were no significant differences in the compliance of non-invasive ventilator,mortality rate and the frequency of acute exacerbations during one year between the two groups（P〉 0.05）.Conclusion：Long-term high-intensity NIPPV for patients with stable COPD complicated with respiratory failure could improve pulmonary function,exercise endurance and the quality of life.