论文部分内容阅读
目的探索与评估家庭无创正压机械通气(HNPPV)长期治疗重度慢性阻塞性肺疾病(COPD)稳定期患者的疗效和安全性。方法将40例经住院治疗处于稳定期的重度 COPD 患者[动脉血二氧化碳分压(PaCO_2)≥55 mm Hg(1 mm Hg=0.133 kPa)]分为常规治疗+HNPPV 组(治疗组)20例和常规治疗组(对照组)20例。分别记录观察前(治疗前)、观察2年后的呼吸困难分级评分、辅助呼吸肌评分、心理情绪评分、肺功能、动脉血气、6分钟行走距离(6MWD);采用超声心动图测定肺动脉平均压(mPAP)、病死率及每年住院次数等指标。结果治疗组与对照组的年龄、性别、身高、体重、呼吸困难分级评分、辅助呼吸肌评分、焦虑评分、抑郁评分、动脉血二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)、用力肺活量(FVC)、第一秒用力呼气容积(FEV_1)、6MWD、mPAP、每年住院次数均具有可比性(t 值分别为1.08、1.15、1.20、1.09、0.86、0.54、0.00、0.00、0.43、0.96、0.76、0.38、0.26、0.24、0.87,P 均>0.05)。2年后治疗组死亡3例(3/20),对照组死亡8例(8/20),两组比较差异无统计学意义(X~2=3.27,P>0.05)。2年后治疗组呼吸困难分级评分、辅助呼吸肌评分、焦虑评分、抑郁评分、PaCO_2、PaO_2、6MWD、mPAP、每年住院次数分别为(2.4±0.5)分、(2.6±0.6)分、(6.9±2.1)分、(6.1±1.6)分、(49.5±2.2)mm Hg、(60.8±4.7)mm Hg、(213±45)m、(30.3±2.2)mm Hg、(1.4±0.4)次/年,与对照组[(3.9±0.3)分、(4.8±0.4)分、(11.2±2.6)分、(11.6±2.1)分、(61.5±2.3)mm Hg、(52.8±2.4)mm Hg、(127±23)m、(36.4±2.3)mm Hg、(3.9±0.3)次/年]比较差异均有统计学意义(t 值分别为9.53、10.83、4.92、7.83、14.07、5.41、6.07、4.81、10.22,P 均<0.01)。结论长期家庭无创正压机械通气对有选择性稳定期重度 COPD 患者疗效较为肯定。
Objective To explore and evaluate the efficacy and safety of home-based non-invasive positive pressure mechanical ventilation (HNPPV) in the long-term treatment of patients with stable chronic obstructive pulmonary disease (COPD). Methods Forty severe COPD patients with stable COPD (arterial carbon dioxide (PaCO_2) ≥55 mm Hg (1 mm Hg = 0.133 kPa)] were divided into two groups: conventional treatment + HNPPV (treatment group) Routine treatment group (control group) 20 cases. Respiratory dysfunction grading score, assisted breathing muscle score, psychological emotion score, pulmonary function, arterial blood gas, 6-minute walking distance (6MWD) were observed before observation (before treatment) and after 2 years. Mean pulmonary artery pressure (mPAP), mortality and number of hospitalizations per year. Results The age, gender, height, weight, dyspnea score, assisted breathing muscle score, anxiety score, depression score, PaCO 2, PaO 2, FVC, FEV 1, 6MWD, mPAP and hospitalization were comparable (t values were 1.08,1.15,1.20,1.09,0.86,0.54,0.00,0.00,0.43, 0.96,0.76,0.38,0.26,0.24,0.87, P> 0.05). After 2 years, the death of the treatment group was 3 cases (3/20), and the death of the control group was 8 cases (8/20). There was no significant difference between the two groups (X ~ 2 = 3.27, P> 0.05). After 2 years, the scores of dyspnea score, auxiliary respiratory muscle score, anxiety score, depression score, PaCO_2, PaO_2, 6MWD and mPAP in the treatment group were (2.4 ± 0.5), (2.6 ± 0.6) and (2.1 ± 1.6) points, (49.5 ± 2.2) mm Hg, (60.8 ± 4.7) mm Hg, (213 ± 45) m, (30.3 ± 2.2) mm Hg and (1.4 ± 0.4) Year, with (3.9 ± 0.3) points, (4.8 ± 0.4) points, (11.2 ± 2.6) points, (11.6 ± 2.1) points, (61.5 ± 2.3) mm Hg, (52.8 ± 2.4) mm Hg, (127 ± 23) m, (36.4 ± 2.3) mm Hg, (3.9 ± 0.3) times / year respectively) (t = 9.53,10.83,4.92,7.83,14.07,5.41,6.07, 4.81,10.22, P <0.01). Conclusion Long-term home noninvasive positive pressure mechanical ventilation in patients with selective stable COPD more positive effect.