长时间用无创正压通气治疗重叠综合征的疗效观察

Observation on Curative Effect of Long-term Noninvasive Positive Pressure Ventilation on Overlap Syndrome

目的探讨长时间用无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停(OSA)(简称重叠综合征)的临床疗效。方法回顾性分析2016年6月至2018年6月在哈尔滨医科大学附属第一医院呼吸内科治疗的66例重叠综合征患者的临床资料,依据NIPPV使用时间不同分为对照组(33例)和试验组(33例)。患者均接受NIPPV和噻托溴铵粉吸入剂治疗。对照组NIPPV使用时间为4 h/d,试验组NIPPV使用时间为8 h/d,两组均治疗6个月。比较两组患者的临床疗效,治疗前后血气分析指标、呼吸频率、心率、第一秒用力呼气量占预计值的百分比(FEV_(1)%)、COPD评估测试(CAT)评分、COPD急性加重(AECOPD)发作次数、改良英国医学研究学会呼吸困难指数(mMRC)分级的变化。结果治疗6个月后,试验组的总有效率高于对照组[93.94%(31/33)比84.85%(28/33)](P<0.05)。治疗6个月后,两组患者的pH值、动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))较治疗前升高(P<0.05),动脉血二氧化碳分压(PaCO_(2))、呼吸频率、心率较治疗前降低(P<0.05);治疗6个月后,试验组PaO_(2)和SaO_(2)高于对照组,PaCO_(2)、呼吸频率、心率低于对照组(P<0.05)。FEV_(1)%、AECOPD发作次数的组间和时点间无交互作用(P>0.05),CAT评分的组间和时点间存在交互作用(P<0.05),治疗6个月后,两组CAT评分降低,试验组低于对照组(P<0.05)。治疗后试验组mMRC分级整体低于对照组(P<0.05)。结论每日8 h NIPPV治疗重叠综合征的疗效更好,可改善患者临床症状和肺功能,提高患者生活质量。

Objective To investigate the clinical efficacy of long-term noninvasive positive pressure ventilation(NIPPV)in the treatment of chronic obstructive pulmonary disease(COPD)combined with obstructive sleep apnea(OSA)(hereinafter referred to as"overlap syndrome").Methods The clinical data of 66 patients with overlap syndrome who were treated in the Department of Respiratory Medicine of the First Affiliated Hospital of Harbin Medical University from Jun.2016 to Jun.2018 were retrospectively analyzed,and divided into a control group(33 cases)and a test group(33 cases)according to the usage time of NIPPV.All the patients received NIPPV and tiotropium bromide powder inhalant.The treatment time of NIPPV in the control group was 4 h/d,and that in the test group was 8 h/d.Both groups were treated for 6 months.The clinical efficacy,blood gas analysis,respiratory rate,heart rate,forced expiratory volume in the first second pred(FEV_(1)%),COPD assessment test(CAT),number of acute exacerbation of COPD(AECOPD)and modified British medical research council(mMRC)dyspnea index grade changes were compared between the two groups.Results After 6 months of treatment,the total effective rate of the test group was higher than that of the control group[93.94%(31/33)vs 84.85%(28/33)](P<0.05).After 6 months of treatment,pH,arterial partial pressure of oxygen(PaO_(2))and arterial oxygen saturation(SaO_(2))in the two groups increased than before treatment(P<0.05),while arterial partial pressure of carbon dioxide(PaCO_(2)),respiratory rate and heart rate decreased than before treatment(P<0.05).After 6 months of treatment,PO_(2) and SaO_(2) in the test group were higher than those in the control group,while PaCO_(2),respiratory rate and heart rate in the test group were lower than those in the control group(P<0.05).There was no interaction in FEV_(1)%and the frequency of AECOPD attack between groups and time points(P>0.05),but there was interaction in CAT score between groups and time points(P<0.05),after 6 months of treatment,CAT scores in the two groups decreased,and those in the test group were lower than those in the control group(P<0.05).After treatment,the overall mMRC grade in the test group was lower than that in the control group(P<0.05).Conclusion NIPPV 8 h a day for the treatment of overlap syndrome is more effective to improve the clinical symptoms,lung function,and the quality of life of the patients.