家庭无创正压通气治疗矽肺合并Ⅱ型呼吸衰竭临床研究

Clinical study of home noninvasive positive pressure ventilation treatment of silicosis patients with respiratory failure

目的探究矽肺合并Ⅱ型呼吸衰竭患者采用基础治疗联合家庭无创正压通气(NPPV)治疗的效果。方法入组85例矽肺合并Ⅱ型呼吸衰竭患者,回顾分析其临床资料,根据其治疗方法分为无创通气治疗组(A组)和基础治疗组(B组)。分析两组患者治疗前后各类指标,包括生命体征、实验室指标、6分钟步行距离(6MWD)、改良呼吸困难指数(mMRC),记录随访1年中两组患者住院频次、住院天数、年死亡率等。结果随访1年结束后,A组患者的心率(HR)、呼吸频率(RR)、血氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(SaO2%)、6MWD、mMRC较B组有显著改善,其差异具有统计学意义(P<0.05);住院频次、住院天数均低于B组,其差异具有统计学意义(P<0.05);但两组间年死亡率差异无统计学意义(P>0.05)。结论家庭NPPV治疗矽肺合并Ⅱ型呼吸衰竭效果显著,表现为临床症状改善、生活质量提升、减少住院频次、缩减住院时间、降低医保负担。

Objective To study the clinical application value of long term home noninvasive positive pressure ventilation in the therapy of silicosis patients with type 2 respiratory failure.Methods A total of 85 silicosis patients with type 2 respiratory failure were enrolled,and their clinical data were retrospectively analyzed.According to the therapeutic method,they were divided into noninvasive positive pressure ventilation group(group A)and basic therapy group(group B).The various indicators of the patients were analyzed before and after the treatment including vital signs,laboratory indicators,6-minute walking distance(6MWD),and modified dyspnea index(mMRC).The admission times,length of hospital stay and annual mortality of the patients were also recorded by follow-up after the treatment for one year.Results After the one year follow-up,the heart rate,respiratory rate,PaO2,PaCO2,SO2%,6MWD,and mMRC of group A were significantly improved than those of group B(all P<0.05).The admission times and the length of hospital stay of group A were lower than those group B(all P<0.05).There was no difference in the annual mortality between the two groups(P>0.05).Conclusions The therapeutic method of home noninvasive positive pressure ventilation has significant effects on silicosis combined with type 2 respiratory failure.It can improve clinical symptoms and the quality of life,and reduce the length of hospital stay and admission times,and reduced medical insurance burden.