无创通气联合肺康复治疗在老年慢性阻塞性肺病稳定期合并高碳酸血症患者中的应用  

Non-invasive Ventilation Combined with Pulmonary Rehabilitation in the Elderly with Stable COPD Complicated with Hypercapnia

作　　者：彭爱君 朱迎钢[2] 许银苹 张华 周理慰 Peng Aijun;Zhu Yinggang;Xu Yinping;Zhang hua;Zhou Liwei(Department of Respiratory Medicine, Zhongren Geriatric Nursing Hospital, Jinshan District, Shanghai, 201501;Departmentof Respiratory and Critical Care Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China)

机构地区：[1]上海市金山区众仁老年护理医院呼吸内科,上海201501 [2]复旦大学附属华东医院呼吸与危重症医学科,上海200040

出　　处：《老年医学与保健》2019年第4期473-475,489,共4页Geriatrics & Health Care

基　　金：上海市卫生计生系统优秀青年医学人才培养计划（2017YQ081)

摘　　要：目的探讨双水平气道正压通气(BiPAP)无创呼吸机通气联合肺康复治疗在老年护理机构慢性阻塞性肺疾病(COPD)稳定期合并高碳酸血症患者中的应用效果。方法选取2018年2月—2019年2月收治的47例老年COPD稳定期合并高碳酸血症接受肺康复的患者,采用随机数字表法随机分成研究组(n=23)和对照组(n=24)。对照组予低流量鼻导管吸氧、化痰、扩张支气管、布地奈德福莫特罗吸入剂、营养治疗、有氧训练、阻抗训练以及心理支持等治疗措施;研究组在对照组的治疗基础上联合给予无创BiPAP治疗。比较2组患者的临床疗效、血气指标、慢性阻塞性肺疾病评估测试(CAT)、6min步行试验(6MWT)、肺功能及并发症发生情况。结果治疗4周,研究组二氧化碳分压和6MWT的改善程度优于对照组,差异有统计学意义(P<0.05);研究组FEV1及FEV1占预计值百分比有所提升,且研究组改善情况优于对照组(P<0.05)。研究组临床疗效总有效率高于对照组(91.3% vs 62.5%,P=0.049),继发肺部感染的发生率低于对照组(26.1% vs 62.5%,P=0.037)。结论BiPAP无创呼吸机通气联合肺康复治疗在合并高碳酸血症的老年COPD稳定期患者中疗效显著,能有效改善患者的临床症状、血气指标及肺功能,降低二氧化碳潴留及呼吸性酸中毒,减少肺部感染的发生率。Objective To explore the application effect of bi-level positive airway pressure (BiPAP) combined with pulmonary rehabilitation on stable chronic obstructive pulmonary disease (COPD) complicated with hypercapnia in the elderly. Methods 47 elderly with stable COPD complicated with hypercapnia during the period from Feb., 2018 to Feb., 2019 were selected and randomly divided into 2 groups: research group (n=23) and control group (n=24);low flow nasal catheter oxygen inhalation, phlegmelimination, bronchial expansion, budesonide formoterol inhalation, nutritional therapy, aerobic training, impedance training and psychological support were provided to the elderly in both groups while non-invasive BiPAP was added to the elderly in research group;a comparative study was made between the 2 groups in clinical curative effect, blood gas index, COPD assessment test (CAT), six-minute walk test (6MWT), pulmonary function and complication occurrence. Results 4 weeks after treatment, the improvement of PaCO2 and 6MWT in research group was much superior to that in control group (P<0.05), and FEV1 and FEV1/predicted (FEV1% pred) increased with a better improvement in research group than in control group (P<0.05);the total clinical effective rate in research group was higher than that in control group (91.3% vs 62.5%,P=0.049) and the occurrence of secondary pulmonary infection in research group was lower than that in control group (26.1% vs 62.5%,P=0.037). Conclusions Non-invasive BiPAP combined with pulmonary rehabilitation is of obvious effect on stable COPD complicated with hypercapnia in the elderly, which can effectively improve the clinical symptoms, blood gas index and pulmonary function, reduced carbon dioxide retention and respiratory acidosis and decrease the occurrence of pulmonary infection.

关 键 词：双水平气道正压通气 慢性阻塞性肺疾病 肺康复 

分 类 号：R473.5[医药卫生—护理学]