家庭无创机械通气对重度慢性阻塞性肺疾病合并高碳酸血症患者的疗效观察及其对凝血功能的影响

Home Noninvasive Mechanical Ventilation On Severe Chronic Obstructive Pulmonary Disease Combined With Hypercarbonemia Patients Observation And Its Effect On Clotting Function

目的探讨长期家庭无创正压机械通气(HNIPPV)在稳定期重度慢性阻塞性肺疾病(COPD)伴持续性高碳酸血症患者中的疗效及其对凝血功能的影响。方法将86例经住院治疗处于稳定期的重度COPD患者[动脉血二氧化碳分压(PaCO2)≥55 mmHg]分为常规治疗+HNIPPV组(研究组)46例和常规治疗组(对照组)40例。分别记录观察前(治疗前)、观察1年后的呼吸困难分级评分、肺功能、动脉血气分析、6分钟行走距离(6 MWD)、每年住院次数、血浆纤维蛋白原及D二聚体等指标。结果治疗一年后,研究组动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、6 MWD、呼吸困难评分、1年内病情恶化住院次数均有所改善,血浆纤维蛋白原及D二聚体降低,研究组较对照组改善明显,差异有统计学意义(P<0.05)。两组患者治疗一年后肺功能指标[用力肺活量(FVC)及一秒用力呼气容积(FEV1)]均有所下降,研究组下降幅度小于对照组,组间比较差异有统计学意义(P<0.05)。结论 HNIPPV治疗可以改善重度COPD患者血气指标,减少急性加重次数,减缓肺功能下降的速度,提高运动耐量,改善患者的血液高凝状态,对于稳定期重度慢阻肺合并高碳酸血症患者是一种有效的治疗方法。

Objective To investigate the efficacy of long-term non-invasive positive pressure mechanical ventilation(HNIPPV)in patients with stable chronic obstructive pulmonary disease(COPD)with persistent hypercapnia and Clotting Function.Methods 86 patients with stable severe COPD after in hospital treatment[arterial blood carbon dioxide partial pressure(PaCO2)≥ 55 mmHg]were divided into conventional treatment + HNIPPV group(study group)46 cases and conventional treatment group(control group)40 cases.The indicators of dyspnea score,lung function,arterial blood gas analysis,6-minute walking distance(6 MWD),the number of hospitalizations per year,plasma fibrinogen and D-dimer were recorded before observation(before treatment),after 1 year of observation.Results After one year of treatment,the study group had improved arterial blood carbon dioxide partial pressure(PaCO2),arterial partial pressure of oxygen(PaO2),6 MWD,dyspnea score,hospitalizations due to disease progression within 1 year,plasma fibrinogen and D-dimer.The study group improved significantly compared with the control group.Statistically significant(P<0.05).After one year of treatment,the lung function indexes[forced vital capacity(FVC)and one-second forced expiratory volume(FEV1)]decreased in the two groups.The decrease in the study group was smaller than that in the control group,and the difference between the groups was statistically significant(P<0.05).Conclusion HNIPPV treatment can improve blood gas index in patients with severe COPD,reduce the number of acute exacerbations,slow down the decline of lung function,improve exercise tolerance and improve the patient’s blood hypercoagulability.It is an effective treatment for patients with stable chronic obstructive pulmonary disease and hypercapnia.