家庭无创正压机械通气对稳定期重度慢性阻塞性肺疾病患者的疗效和安全性观察被引量：38

The efficacy and safety of long term home noninvasive positive pressure ventilation in patients with stable severe chronic obstructive pulmonary disease

原文传递

导出

摘要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 evaluate the long term efficacy and safety of long term home noninvasive positive pressure ventilation （HNPPV） in stable hypercapnic patients with chronic obstructive pulmonary disease （COPD）. Methods Forty patients with stable severe COPD [ arterial PaCO2 ≥ 55 mm Hg （ 1 mm Hg = 0. 133 kPa） ] after hospital discharge were divided into 2 groups： the HNPPV group （ n = 20） with conventional therapy and HNPPV, and the control group （n = 20 ） with conventional therapy only. Parameters before and after 2 year follow-up observation were compared, which included dyspnea grade, scale for accessory muscle use, scoring for emotional disorders, lung function test, arterial blood gases, 6-min walking distance （6MWD）, mean pulmonary arterial pressure （mPAP） by electrocardiography, mortality and hospitalization rates. Results The age, gender, height, weight, dyspnea grade, scale for accessory muscle use, anxiety scores, depression scores, 6MWD, mPAP, arterial PaCO2 and PaO2, FVC, FEV,, and hospitalization rates of the 2 groups on admission were similar （ 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 and 0. 87 respectively, all P 〉 0. 05 ）. The mortality was reduced slightly by HNPPV but with no statistically significant difference （3/20 and 8/20, respectively, χ^2 = 3.27,P 〉 0. 05）. After 2 years, the difference of the dyspnea grade, scale for accessory muscle use, anxiety scores, depression scores, arterial PaCO2 and PaO2, 6MWD, mean pulmonary artery pressure, and hospitalization rates in the HNPPV group [ 2. 4 ± 0. 5, 2.6 ± 0. 6, 6.9 ± 2.1, 6.1 ±1.6, （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） times/year] was statistically significant compared to the control group [3.9 ±0. 3,4. 8 ±0. 4, 11.2±2.6, 11.6±2.1,（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] （t values were 9. 53, 10. 83, 4. 92, 7. 83, 14. 07, 5.41, 6. 07, 4. 81 and 10. 22 respectively, all P 〈 0. 01 ）. Conclusion Long-term use of home noninvasive positive ventilation in patients with stable severe COPD is effective and safe.

作者向平超张鑫杨珺楠张二明郭伟安鞠立新张硕朱卫京雷涛程显声

机构地区北京大学首钢医院呼吸科中国医学科学院中国协和医科大学阜外心血管病医院肺血管病诊治中心

出处《中华结核和呼吸杂志》 CAS CSCD 北大核心 2007年第10期746-750,共5页 Chinese Journal of Tuberculosis and Respiratory Diseases

关键词肺疾病慢性阻塞性无创正压机械通气家庭机械通气呼吸功能不全高碳酸血症 Pulmonary disease, chronic obstructive Noninvasive positive pressure ventilation Home mechanical ventilation Respiratory insufficiency Hyporcapnic

分类号 R563.9 [医药卫生—呼吸系统]

引文网络
相关文献

参考文献11

1慢性阻塞性肺疾病诊治指南[J].中华结核和呼吸杂志,2002,25(8):453-460. 被引量：5104
2Bestall JC, Paul EA, Garrod R, et al. Usefulness of the Medical Research Council(MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax, 1999,54:581-586.
3Patrick W, Webster K, Ludwig L, et al. Noninvasive positive- pressure ventilation in acute respiratory distress without prior chronic respiratory failure. Am J Respir Crit Care Med, 1996, 153:1005-1011.
4Simonds AK. Home ventilation. Eur Respir J Suppl, 2003,47: 38s-46s.
5Janssens JP, Derivaz S, Breitenstein E, et al. Changing patterns in long-term noninvasive ventilation : a 7-year prospective study in the Geneva Lake area. Chest, 2003,123:67-79.
6Goldberg A, Hill NS. Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation-a consensus conference report. Chest, 1999, 116:521-534.
7Hill NS. Noninvasive ventilation in chronic obstructive pulmonary disease. Clin Chest Med, 2000,21:783-797.
8Diaz O, Begin P, Andresen M, et al. Physiological and clinical effects of diurnal noninvasive ventilation in hypercapnic COPD. Eur Respir J, 2005,26:1016-1023.
9Windisch W, Kostic S, Dreher M, et al. Outcome of patients with stable COPD receiving controlled noninvasive positive pressure ventilation aimed at a maximal reduction of Pa (CO2 ). Chest, 2005,128:657-662.
10Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med, 1980, 93:391-398.