家庭夜间无创正压通气联合吸气肌锻炼对稳定期COPD合并高碳酸血症患者治疗一年疗效观察  

Observation on the 1-year Efficacy of Home-based Nocturnal Noninvasive Mechanical Ventilation Joint Inspiratory Muscle Exercise for the Treatment of Patients with Stable COPD and Hypercapnia

作　　者：尹辉明[1] 蒋玉兰[1] 周牡丹[1] 

机构地区：[1]怀化医专附属医院暨怀化市第三人民医院呼吸内科,湖南怀化418000

出　　处：《医学临床研究》2014年第9期1681-1684,共4页Journal of Clinical Research

基　　金：湖南省科技厅立项课题（课题编号2012FJ4496）

摘　　要：[目的]评估家庭夜间无创正压通气（noninvasive positive pressure ventilation,NPPV）联合吸气肌锻炼治疗稳定期慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）合并高碳酸血症患者治疗1年的疗效.[方法]40例老年慢性高碳酸型呼吸衰竭患者,接受家庭应用NPPV治疗及吸气肌锻炼治疗,随访1年,评价治疗前后6 min步行距离、呼吸困难评分、辅助呼吸肌评分、平均肺动脉压（mPAP）、用力肺活量（FVC）、一秒用力呼气容积（FEV1）值、日间动脉氧分压（PaO2）及动脉二氧化碳分压（PaCO2）值及两年COPD急性加重次数.[结果]治疗前及治疗1年后比较：①6 min步行距离[（70±15）m vs （110±20）m],呼吸困难评分[（4.4±0.3）分vs （2.4±0.1）分],辅助呼吸机评分[（4.8±0.2）分vs （2.2±0.3）分],急性加重次数[（4.3±2.1）分vs（2.1±0.7）分]均较治疗前明显改善,差异有统计学意义（均P ＜0.01）;②治疗前及治疗1年后比较mPAP[（43.5±3.8）mmHg vs （34.4±2.7） mmHg]、PaCO2[（64.3±5.2）mmHg vs （49.8±4.9）mmHg]、PaO2[（52.3±3.9） mmHgvs（64.4±4.1）mmHg]均较治疗前明显改善,差异有统计学意义（均P＜0.001）,FEV1[（1.21±1.1）L vs （1.24±0.9）L]及FVC[（2.48±0.8）mmHg vs （2.49±0.7）mmHg]有改善,但差异无统计学意义（P＞0.05）.[结论]长期家庭夜间无创机械通气联合吸气肌锻炼对稳定期COPD合并高碳酸血症患者治疗安全有效,值得临床推广.[Objective]To evaluate the 1-year efficacy of home-based nocturnal noninvasive mechanical ventilation （NPPV） joint inspiratory muscle exercise for the treatment of stable patients with chronic obstructive pulmonary disease （COPD） and hypercapnia.[Methods] A total of 40 elderly patients with chronic high calcareous type of respiratory failure received home-based nocturnal NPPV treatment and inspiratory muscle exercise,and were followed up for 1 year.The 6-minute walking distance,dyspnea score,auxiliary ventilator score,mean pulmonary artery pressure（mPAP）,FEV1 value,daytime PaO2 and PaCO2 value and the frequency of acute COPD exacerbations in 2 years were evaluated before and after treatment.[Results] Compared with before treatment,the 6-minute walking distance[（70± 15）m vs.（110±20） m],dyspnea score[（4.4±0.3） vs.（2.4±0.1）],auxiliary ventilator score[（4.8±0.2） vs.（2.2±0.3）],the frequency of acute exacerbations[（4.3± 2.1） vs.（2.1± 0.7）] 1 year after treatment were obviously improved,and there were significant differences（all P ＜0.01）.Compared with before treatment,the mPAP[（43.5 ± 3.8）mmHg vs.（34.4± 2.7） mmHg],PaCO2 [（64.3±5.2）mmHg vs.（49.8±4.9）mmHg] and PaO2[（52.3±3.9）mmHg vs.（4.4±4.1）mmHg] 1 year after treatment were obviously improved,and there were significant differences（all P ＜0.01）.Compared with before treatment,FEV1[（1.21±1.1）L vs.（1.24±0.9）L] and FVC[（2.48±0.8）mmHg vs.（2.49±0.7）mmHg] were improved,but there was no significant difference（P ＞0.05）.[Conclusion] Long-term home-based nocturnal noninvasive mechanical ventilation joint inspiratory muscle exercise for the treatment of patients with stable COPD and hypercapnia is safe and effective.Therefore,it is worthy of clinical promotion.

关 键 词：呼吸 人工 正压呼吸 肺疾病 慢性阻塞性/并发症 高碳酸血/并发症 呼吸肌 

分 类 号：R563[医药卫生—呼吸系统]