肺康复训练联合无创通气对COPD-OSAHS重叠综合征患者治疗效果研究

Study on the effect of pulmonary rehabilitation training combined with non-invasive ventilation on patients with COPD-OSAHS overlap syndrome

目的探讨肺康复训练联合BiPAP模式通气对慢性阻塞性肺疾病(COPD)伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)重叠综合征患者的临床疗效。方法选择2019年3月至2020年3月广东省江门市人民医院收治的COPD-OSAHS重叠综合征患者101例,按随机化原则分为治疗组51例和对照组50例,所有患者均予呼吸操肺康复治疗及呼吸科常规治疗,治疗组在对照组的基础上加用BiPAP无创通气,疗程半年。治疗结束后对患者治疗前后及组间进行比较,比较患者血气分析、睡眠呼吸暂停低通气指数(AHI)、肺功能、MMRC评分、CAT评分及生活质量评分。结果治疗组患者PaCO_(2)、睡眠AHI指数、mMRC评分、CAT评分、圣乔治呼吸问卷评分(SGRQ)均低于对照组,差异均有统计学意义(P<0.05)。治疗组患者PaO_(2)、PaO_(2)/FiO_(2)、FEV1均高于对照组,差异均有统计学意义(P<0.05)。结论肺康复训练联合无创呼吸机BiPAP模式通气治疗可以改善患者通气状况,减少二氧化碳潴留,降低AHI指数,提高生存质量,减少急性加重发作次数,值得临床推荐。

Objective To explore the clinical effect of pulmonary rehabilitation training combined with BiPAP ventilation on patients with chronic obstructive pulmonary disease(COPD)and obstructive sleep apnea hypopnea syndrome(OSAHS)overlap syndrome.Methods A total of 101 patients with COPD-OSAHS overlap syndrome admitted to the People′s Hospital of Jiangmen City in Guangdong Province from March 2019 to March 2020 were selected and divided into the treatment group of 51 cases and the control group of 50 cases according to the principle of randomization.All patients were treated with pulmonary rehabilitation of respiratory exercises and routine therapy in respiratory department.The treatment group was additionally given BiPAP non-invasive ventilation on the basis of the control group′s treatment,which continued for half a year.Upon the ending of the treatment,the comparison before and after treatment and the comparison between groups were conducted,and the blood gas analysis,sleep apnea hypopnea index(AHI),lung function,MMRC score,CAT score and quality of life score were compared.Results The PaCO_(2),sleep AHI index,mMRC score,CAT score,and Saint George's Respiratory Questionnaire(SGRQ)score in the treatment group were lower than those in the control group,and the differences were statistically significant(P<0.05).The PaO_(2),PaO_(2)/FiO_(2),FEV1 in the treatment group were higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Pulmonary rehabilitation training combined with BiPAP ventilation therapy by non-invasive ventilator can improve patient′s ventilation,reduce CO_(2) retention,lower AHI index,increase quality of life,and decrease the number of acute exacerbations.It is worthy of clinical recommendation.