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

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.

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

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.