家庭机械通气联合氧疗对重度慢性阻塞性肺疾病稳定期的疗效分析  

Curative effect analysis of home mechanical ventilation plus oxygen therapy on severe stable chronic obstructive pulmonary disease

作　　者：耿婉如[1] 陈永彪[1] 李立飞[1] 庞宝森[2] 

机构地区：[1]内蒙古民族大学附属医院呼吸内科,内蒙古通辽028000 [2]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京100032

出　　处：《临床肺科杂志》2017年第7期1237-1240,共4页Journal of Clinical Pulmonary Medicine

基　　金：内蒙古民族大学自然科学研究项目基金赞助(No NMDYB15067)

摘　　要：目的研究家庭机械通气联合氧疗在重度慢性阻塞性肺疾病稳定期中的疗效。方法选择符合以下条件的病人入组:(1)按照2011版慢性阻塞肺部疾病全球倡议的诊断标准符合慢性阻塞性肺部疾病诊断;(2)按照慢阻肺肺功能分级均为重度患者,即30%≤FEV1<50%;(3)住院期间曾接受无创正压机械通气的患者,病情好转,达到出院标准。其中离院后购买家庭无创呼吸机的患者共16例入治疗组,并将未行机械通气的23例患者入对照组。观察治疗组和对照组在出院后1年之内的观察期内的住院次数、住院总天数、住院费用,并分别比较他们在观察期的PaO_2和PaCO_2变化情况,通过电话随访进行生活质量评分测定。结果治疗组在接受家庭机械通气后1年的PaO_2和PaCO_2变化差异有统计学意义(P<0.05),而对照组的变化则无统计学意义(P>0.05)。与对照组相比,治疗组的住院天数及住院费用的减少均具有统计学意义(P<0.05),但二者的住院次数和生活质量评分不具有统计学差异(P>0.05)。结论对于重度慢性阻塞性肺部疾病稳定期患者进行家庭机械通气可以改善实现医院治疗与家庭护理之间的序贯治疗,是一项可以选择的常规治疗方式。Objective To explore the curative effect of home mechanical ventilation plus oxygen therapy on severe stable chronic obstructive pulmonary disease. Methods Those patients met the following conditions were selected in this study： ① they were diagnosed chronic obstructive pulmonary disease according to diagnostic criteria of the 2011 GOLD;② they were diagnosed as severe COPD according to their lung function,that was 30% ≤ FEV1 〈 50% ; ③ they received non-invasive positive pressure ventilation therapy in our hospital from January 2013 to January 2015, and then they left the hospital with a improved symptom. According to the purchase of noninvasive ventilator, the enrolled patients were divided into the treatment group and the control group. 16 patients had their own noninva-sive ventilator and worn it more than 4 hours plus oxygen therapy every day were enrolled into the treatment group, while the others 23 patients received normal medical therapy such as inhaled corticosteroid were enrolled into the control group. They were followed up 1 year from the day leaving hospital. Their arterial blood gas （ PaO2,PaC02）, hospital stay and cost, and life quality score were compared by St. Georges respiratory questionnaire. Results The level of PaC02 decreased and PaO2 increased significantly 1 year after treatment （P 〈 0 .0 5 ） , while the control group didn, timproved significantly （ P 〉 0. 05 ） . The hospital stay and cost was significantly lower in the treatment group than in the control group （ P 〈 0. 05 ） . However, there was no significant difference in hospitalization times and life quality score between the two groups （P 〉0. 05）. Conclusion Home mechanical ventilation, as a bridge connection from hospital therapy to home therapy, is a kind of optional therapy for severe stable COPD patients.

关 键 词：家庭机械通气 无创呼吸机 稳定期慢性阻塞性肺疾病 

分 类 号：R563.9[医药卫生—呼吸系统]