无创正压通气对间质性肺疾病所致呼吸衰竭稳定期患者的肺康复治疗效果及生活质量改善观察

Observation on the effect of noninvasive positive pressure ventilation on pulmonary rehabilitation and quality of life in patients with respiratory failure caused by interstitial lung disease in stable stage

目的观察无创正压通气(NPPV)对间质性肺疾病(ILD)所致呼吸衰竭稳定期患者的肺康复治疗效果及生活质量改善情况。方法选取2016年7—12月新疆医科大学第一附属医院呼吸与呼吸危重症中心诊治的ILD合并呼吸衰竭患者40例作为研究对象,以随机数字表法分成2组,每组20例。对照组行常规药物+家庭氧疗,观察组行常规药物+NPPV治疗。随访2年,观察并比较2组治疗前后血清炎性因子、血气指标、肺功能、运动能力和生活质量。结果与治疗前比较,治疗1、2年后2组的血清C反应蛋白(CRP)、动脉血二氧化碳分压(PaCO_2)、圣乔治呼吸问卷(SGRQ)评分均降低(F/P_(对照组)=5.627/0.014、3.071/0.035、3.845/0.024;F/P_(观察组)=7.481/0.008、3.224/0.032、4.126/0.022),动脉血氧分压(PaO_2)、肺总量(TLC)、肺活量(VC)、功能残气量(FRC)、第1秒用力呼气末容积(FEV_1)占用力肺活量(FVC)的百分比(FEV_1/FVC)、一氧化碳弥散量(DLCO)占预计值的百分比(DLCO%)和6分钟步行试验(6MWT)较治疗前升高(F/P_(对照组)=7.524/0.007、4.722/0.018、4.561/0.019、4.273/0.021、5.251/0.016、5.627/0.014、7.436/0.007;F/P_(观察组)=8.358/0.005、5.306/0.016、5.086/0.017、4.885/0.018、6.436/0.010、6.144/0.012、8.564/0.005),其中观察组的CRP、PaO_2、TLC、VC、FRC、FEV_1/FVC、DLCO%和6MWT、SGRQ较对照组改善更显著(t/P_(1年)=3.852/0.022、6.342/0.010、4.045/0.022、4.013/0.025、3.604/0.026、4.515/0.019、3.355/0.027、5.802/0.012、3.624/0.026;t/P_(2年)=3.173/0.033、7.051/0.008、4.368/0.020、4.176/0.024、3.906/0.025、4.337/0.020、3.689/0.025、5.371/0.015、3.458/0.027)。结论无创正压通气对间质性肺疾病所致呼吸衰竭稳定期患者肺康复的治疗效果更为显著,可明显改善患者血气指标和肺功能,提高患者运动能力和生活质量。

Objective To observe the effect of noninvasive positive pressure ventilation(NPPV)on pulmonary rehabilitation and quality of life in patients with respiratory failure caused by interstitial lung disease(ILD)in stable stage.Methods Forty patients with ILD complicated with respiratory failure were selected from the Respiratory and Respiratory Critical Care Center of the First Affiliated Hospital of Xinjiang Medical University from July to December 2016.They were randomly divided into two groups with 20 cases in each group.The control group was treated with routine drugs plus home oxygen therapy,while the observation group was treated with routine drugs plus NPPV.After 2 years of follow-up,the serum inflammatory factors,blood gas index,lung function,exercise ability and quality of life were observed and compared between the two groups before and after treatment.Results Compared with before treatment,serum C-reactive protein(CRP),arterial blood carbon dioxide partial pressure(PaCO 2),and St.George's Respiratory Questionnaire(SGRQ)scores were decreased in both groups after 1 and 2 years of treatment(control group:F/P=5.627/0.014,F/P=3.071/0.035,F/P=3.845/0.024;Observation group:F/P=7.481/0.008,F/P=3.224/0.032,F/P=4.126/0.022),arterial oxygen Partial pressure(PaO 2),total lung volume(TLC),vital capacity(VC),functional residual capacity(FRC),percentage of forced vital capacity at the end of forced expiratory volume(FEV 1/FVC),The percentage of carbon monoxide diffusion(DLCO)as a percentage of the predicted value(DLCO%)and the 6-minute walk test(6MWT)were higher than before treatment(control group:F/P=7.524/0.007,F/P=4.722/0.018,F/P=4.561/0.019,F/P=4.273/0.021,F/P=5.251/0.016,F/P=5.627/0.014,F/P=7.436/0.007;observation group:F/P=8.358/0.005,F/P=5.306/0.016,F/P=5.086/0.017,F/P=4.885/0.018,F/P=6.436/0.010,F/P=6.144/0.012,F/P=8.564/0.005),where observation The CRP,PaO 2,TLC,VC,FRC,FEV 1/FVC,DLCO%and 6MWT,SGRQ of the group were more significant than the control group(1 year:t/P=3.852/0.022,t/P=6.342/0.010,t/P=4.045/0.022,t/P=4.013/0.025,t/P=3.604/0.026,t/P=4.515/0.019,t/P=3.355/0.027,t/P=5.802/0.012,t/P=3.624/0.026;2 years:t/P=3.173/0.033,t/P=7.051/0.008,t/P=4.368/0.020,t/P=4.176/0.024,t/P=3.906/0.025,t/P=4.337/0.020,t/P=3.689/0.025,t/P=5.371/0.015,t/P=3.458/0.027).Conclusion Non-invasive positive pressure ventilation is more effective in the treatment of pulmonary rehabilitation of patients with respiratory failure caused by interstitial lung disease in stable stage.It can significantly improve the blood gas index and pulmonary function of patients,and improve the exercise ability and quality of life of patients.