短期呼吸肌训练联合无创正压通气对慢性阻塞性肺疾病急性加重患者的疗效

Efficacy of short-term respiratory muscle training combined with non-invasive positive pressure ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease

目的:探讨短期手动抗阻呼吸肌训练联合无创正压通气(NPPV)对慢性阻塞性肺疾病急性加重(AECOPD)患者的临床疗效。方法:选择住院且符合相应标准的AECOPD患者69例。患者入院后分为观察组35例与对照组34例。对照组使用无创正压通气、平喘等常规治疗,观察组在对照组基础上增加主动抗阻呼吸肌训练。结果:2组患者治疗后慢性阻塞性肺疾病评估测试(CAT)评分、改良英国医学研究委员会呼吸困难量表(mMRC)评分、二氧化碳分压(PaCO_(2))、第1秒用力呼气量占预计值百分比(FEV1%)与第1秒用力呼气量(FEV1)/用力肺活量(FVC)较治疗前明显改善(P<0.05);观察组患者治疗后上述指标较对照组改善更加明显(P<0.05)。观察组患者治疗后最大吸气压(MIP)与最大呼气压(MEP)较治疗前明显升高(P<0.05)。观察组患者治疗后白细胞介素-8(IL-8)与肿瘤坏死因子-α(TNF-α)较对照组降低更为明显(P<0.05)。结论:短期主动抗阻呼吸肌训练联合NPPV等常规治疗能进一步缓解AECOPD患者临床症状与呼吸困难,改善通气与肺功能,降低全身炎症反应水平。

Objective:To investigate the clinical efficacy of short-term manual resistance respiratory muscle training combined with non-invasive positive pressure ventilation(NPPV)in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 69 in-hospital patients with AECOPD who met the corresponding criteria were selected.After admission,they were divided into observation group(35 cases)and control group(34 cases).The control group received conventional treatments such as traditional lung rehabilitation breathing training,non-invasive positive pressure ventilation(NPPV),and so on,and the observation group was given manual resistance respiratory muscle training on the basis of conventional treatment.Results:After treatment,the chronic obstructive pulmonary disease assessment test(CAT)score,modified British Medical Research Council dyspnea scale(mMRC)score,partial pressure of carbon dioxide(PaCO_(2)),and the ratio of forced expiratory volume in the first second(FEV1)/forced vital capacity(FVC)were significantly improved compared with those before treatment(P<0.05).The maximum inspiratory pressure(MIP)and maximum expiratory pressure(MEP)of the observation group after treatment were significantly higher than those before treatment(P<0.05).After treatment,serium interleukin-8(IL-8)and tumor necrosis factor-α(TNF-α)in the observation group were significantly lower than those in the control group(P<0.05).Conclusion:Short-term manual resistance respiratory muscle training combined with NPPV and other conventional treatments can further relieve the clinical symptoms and dyspnea of patients with AECOPD,improve their ventilations and lung functions,and reduce the level of systemic inflammatory response.