严重COPD患者稳定期长期无创正压通气治疗临床疗效及依从性观察  

Efficacy and Compliance With Long-term Controlled Trial of Non-Invasive Positive Pressure Ventilation in Patients With stable Severe COPD

作　　者：欧阳修河[1] 胡翠花[1] 李玉[2] 郑文涛[1] 于立萍[1] 王新安[1] 

机构地区：[1]山东省滨州市人民医院,256610 [2]山东大学齐鲁医院,济南250012

出　　处：《医学研究杂志》2009年第4期69-72,共4页Journal of Medical Research

摘　　要：目的观察稳定期严重COPD患者长期无创通气治疗的临床疗效和治疗依从性。方法选择64例严重COPD患者(FEV1<45%),随机分为实验组和对照组,两组患者均给予为期1年的吸氧、口服茶碱缓释片、吸入舒利等治疗,治疗组在此基础上加用双水平无创正压通气治疗1年。分别对两组患者回顾记录上1年及治疗后1年内急性发作及相关情况,以圣骄治问卷评价患者治疗前后生活质量、6min行走距离、动脉血气分析及肺功能检查等,记录两组患者1年内治疗依从性和3年内死亡情况。结果实验组8例、对照组5例因各种原因退出实验。其余两组患者治疗后生活质量评分实验组为63.5±6.8vs43.5±4.3(P<0.01)、对照组为62.8±6.4vs52.8±5.2(P<0.05),组间比P<0.05。6min行走距离试验组为148±56米vs296±83米(P<0.01)、对照组为158±58米vs242±86米(P<0.05),均明显提高。呼吸困难程度明显改善,急性发作次数、住院天数等明显减少,实验组优于对照组;动脉血气分析、肺功能改善治疗组优于对照组。1年内治疗组死亡3例、对照组死亡4例,组间比差异无统计学意义,2～3年对照组死亡6例,实验组死亡1例,组间差异显著。结论严重COPD患者长期无创通气治疗可明显改善患者生存状况,减少急性发作,减少病死率。Objective To determine the efficacy and Compliance of non - invasive positive pressure ventilation （NPPV） for long - term therapy in patients with stable severe chronic obstructive pulmonary disease （COPD）. Methods We prospectively randomized 64 outpatients with severe COPD （FEV1 〈 45% ） divided into two groups （experimental group and Control group） treated with oxygen therapy, slow -release oral theophylline, inhalation of Seretide for one year, and added to 1 year NPPV therapy in Treatment group. The outcomes measures included the following：rate of acute COPD exacerbations; hospital admissions at retrospective last 1 year and follow 12 months; and mortality. The patients were also evaluated at begin and 12 months for dyspnea using the ATS/ERS Test Force, gas exchange, pulmonary function, and assess Health- Related Quality of Life （HRQL） with St. George Respiratory Questionnaire and a 6 - min walk test （6 - MWT） were performed. Then the compliance for one year and the mortality with in 2-3 yeas were recorded. Results 8 patients in experimental group and 5 patients in control group have 5 abnegated treatment due to a variety of reasons. Three died in experimental group, and four died in control group during the first one years ,and one died in treatment group, sixe died between the second to the third year in Control group, the mortality significant decreased in experimental group. The other cases HRQL of Experimental group 63.5±6.8 vs 43.5±4.3（P 〈0.01） ,and Control group 62.8±6.4vs52.8 ＋5.2（P 〈0. 05） , level of dyspnea and the 6 - MWT Experimental group（148±56） m vs（296 ±83） m（P 〈0.01） ,and Control group （158±58） m vs （242±86） m,have significantly improved. Significantly lower in patients of rate of COPD exacerbation and re - hospitalization, which was better of therapy by NPPV patients than that in the Control group. Blood gas levels and lung function significantly improved, and Experimental group excelled. Conclusion Our study indicates th

关 键 词：肺疾病 慢性阻塞性 无创通气 随机对照试验 COMPLIANCE 

分 类 号：R766.43[医药卫生—耳鼻咽喉科] R511.6[医药卫生—临床医学]