肺康复联合无创正压通气治疗COPD合并呼吸衰竭患者疗效观察

Clinical analysis of pulmonary rehabilitation combined with noninvasive positive pressure ventilation in the treatment of COPD patients with respiratory failure

目的观察肺康复联合无创正压通气治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者的临床疗效。方法选择肇庆市第一人民医院呼吸内科2017年1月至2019年12月收治的52例COPD合并呼吸衰竭患者,按照随机数表法分为观察组和对照组,每组26例,对照组患者在常规治疗基础上使用无创正压通气治疗,观察组患者在对照组治疗基础上联合肺康复治疗,均持续治疗4周。比较两组患者治疗4周后的临床疗效、治疗前及治疗后的最大呼气第一秒呼出的气量的容积(FEV_(1))、FEV_(1)/用力肺活量(FEV_(1)/FVC)、改良版英国医学研究委员会呼吸问卷(mMRC)评分、心率(HR)、呼吸频率(RR)、动脉血氧分压(PaO_(2))、动脉二氧化氮分压(PaCO_(2))、6-min步行距离以及气管插管率、死亡率和ICU住院时间。结果治疗后,观察组患者的总有效率为92.31%,明显高于对照组的69.23%,差异有统计学意义(P<0.05);治疗后,观察组患者的FEV_(1)、FEV_(1)/FVC分别为(2.07±0.21)L、(63.12±4.06)%,明显高于对照组的(1.75±0.17)L、(58.71±3.29)%,mMRC评分为(1.12±0.09)分,明显低于对照组的(1.57±0.11)分,差异均有统计学意义(P<0.05);治疗后,观察组患者的HR、RR、PaCO_(2)分别为(89.53±6.51)次/min、(16.06±2.14)次/min、(45.05±4.93)mmHg,明显低于对照组的(97.31±5.07)次/min、(19.32±1.49)次/min、(52.31±4.24)mmHg,PaO_(2)为(73.03±4.75)mmHg,明显高于对照组的(65.25±4.51)mmHg,差异均有统计学意义(P<0.05);治疗后,观察组患者的6 min步行距离为(398.73±26.18)m,明显长于对照组的(341.20±24.76)m,差异有统计学意义(P<0.05);观察组患者的气管插管率为3.85%,明显低于对照组的23.08%,ICU住院时间为(10.02±2.03)d,明显短于对照组的(14.51±2.51)d,差异均有统计学意义(P<0.05);观察组和对照组患者的死亡率分别为3.85%和11.54%,差异无统计学意义(P>0.05)。结论肺康复联合无创正压通气治疗COPD合并呼吸衰竭有助于促进患者的肺功能和血气指标恢复,缓解病情,临床治疗效果显著。

Objective To observe the clinical effect pulmonary rehabilitation combined with noninvasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease(COPD)with respiratory failure.Methods A total of 52 COPD patients with respiratory failure,who admitted to Department of Respiratory Medicine,Zhaoqing First People's Hospital from January 2017 to December 2019,were selected and divided into the observation group and control group according to random number table method,with 26 patients in each group.The control group was treated with noninvasive positive pressure ventilation on the basis of conventional treatment,and the observation group was treated with lung rehabilitation therapy on the basis of the control group,for 4 weeks.The clinical efficacy at 4 weeks after treatment,the changes of the maximal expiratory volume(FEV_(1))and FEV_(1)/forced vital capacity(FEV_(1)/FVC),Modified British Medical Research Council Respiratory Questionnaire(mMRC),heart rate(HR),respiratory rate(RR),arterial partial pressure of oxygen(PaO_(2)),partial pressure of nitrogen dioxide(PaCO_(2))and 6-min walking distance before treatment and 4 weeks after treatment,and the intubation rate,mortality rate and ICU hospitalization of the two groups were compared.Results After treatment,the total effective rate in the observation group was 92.31%,which was significantly higher than 69.23%of the control group(P<0.05);FEV_(1) and FEV_(1)/FVC in the observation group were(2.07±0.21)L and(63.12±4.06)%,respectively,which were significantly higher than corresponding(1.75±0.17)L and(58.71±3.29)%of the control group,while the mMRC score was(1.12±0.09)points,which was significantly lower than(1.57±0.11)points in the control group(all P<0.05);HR,RR and PaCO_(2) in the observation group were(89.53±6.51)times/min,(16.06±2.14)times/min,(45.05±4.93)mmHg,respectively,which were significantly lower than corresponding(97.31±5.07)times/min,(19.32±1.49)times/min,(52.31±4.24)mmHg of the control group,while the PaO_(2) was(73.03±4.75)mmHg,which was significantly higher than(65.25±4.51)mmHg in the control group(all P<0.05);the 6-min walking distance of the observation group was(398.73±26.18)m,which was significantly longer than(341.20±24.76)m of the control group(P<0.05);the tracheal intubation rate in the observation group was 3.85%,which was significantly lower than 23.08%of the control group,and the ICU hospitalization time was(10.02±2.03)d,which was sigdoinificantly shorter than(14.51±2.51)d in the control group(P<0.05);the mortality of the observation group was 3.85%versus 11.54%of the control group(P>0.05).Conclusion Lung rehabilitation combined with noninvasive positive pressure ventilation in the treatment of COPD with respiratory failure is helpful to promote the recovery of lung function and blood gas indexes,and alleviate the disease condition,with significant clinical treatment effects.