无创正压通气对慢性阻塞性肺疾病合并肺动脉高压患者疗效分析

目的探讨无创正压通气对慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者的治疗作用。方法入选对象为本科室病房2014年10月至2016年1月收治入院经治疗达到COPD稳定期且合并肺动脉高压的136例患者。所有患者通过超声心动图检查收缩期肺动脉压(sPAP)40 mm Hg。136例患者中男121例,女15例,平均年龄(60.3±11.3)岁,随机分为无创正压通气(NPPV)组和常规治疗组。比较两组治疗前后FEV1/预计值、氧合指数、PCO_2、sPAP、BNP指标的差异,并进行sPAP与氧合指数、PCO_2、BNP、FEV1/预计值的相关性分析。结果 (1)NPPV组治疗后与治疗前以及与常规组治疗后在氧合指数、PCO_2、BNP较前有明显改善(P0.05),而FEV1/预计值、sPAP无统计学差异(P0.05)。常规组治疗前后无统计学意义(P0.05);(2)根据sPAP值分为A组(40 mm HgsPAP≤60 mm Hg)以及B组(sPAP60 mm Hg)进行分层研究显示:常规组治疗前后对应A、B亚组在FEV1/预计值、氧合指数、PCO_2、BNP、sPAP均无统计学差异(P0.05)。NPPV治疗组A组治疗后患者氧合指数、PCO_2、BNP、sPAP较治疗前及常规组A组治疗后均有改善(P0.05);B组治疗后在氧合指数、PCO2、BNP较治疗前及常规组B组治疗后有明显改善(P0.05),而FEV1/预计值、sPAP无统计学差异(P0.05);(3)sPAP与氧合指数呈负相关,与BNP呈正相关(P0.05)。结论无创正压通气治疗老年慢性阻塞性肺疾病合并轻度肺动脉高压患者安全有效,可以减低肺动脉高压。

Efficacy of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension

Objective To investigate the therapeutic effect of noninvasive positive pressure ventilation on chronic obstructive pulmonary disease (COPD) complicated with pulmonary hypertension (PH).Method Patients admitted to hospital from October 2014 to January 2016 were treated with stable COPD and pulmonary hypertension,and sPAP was measured by echocardiography in all patients (＞ 40 mmHg).136 patients,including 121 males and 15 females,with an average age of (60.3± 11.3)years,were randomly divided into noninvasive positive pressure ventilation (NPPV) group and conventional treatment group.The FEV1/predictive value,oxygenation index,PCO2,sPAP,BNP were compared between the two groups before and after treatment,and the correlation between sPAP and the oxygenation index,PCO2,BNP and FEV1/predictive value were analyzed.Result ①There was significantly improved between the NPPV group after treatment and NPPV group before treatment and the conventional group after treatment in the oxygenation index,PCO2,BNP (P＜0.05),but FEV1/predicted value,sPAP no statistical difference (P＞0.05).There was no significant difference between the two groups before and after treatment in conventional group (P＞0.05);②According to the values of sPAP were divided into A group (40 mmHg＜sPAP ≤60 mmHg) and B group (sPAP＞60 mmHg).Stratified study showed that the FEV1/predictive value,BNP,sPAP were not significantly different before and after treatment between the group A and group B in the conventional group (P＞0.05).The oxygenation index,PCO2,BNP,sPAP in NPPV after treatment of group A were improved between the NPPV before treatment and the conventional after treatment in group A (P＜0.05);the oxygenation index,PCO2,BNP in B group after treatment were significantly improved than before treatment and the conventional after treatment in group B (P＜0.05),but FEV1/predicted value,sPAP no statistical difference (P＞0.05);③sPAP was negatively correlated with oxygenation index and positively correlated with BNP (P ＜ 0.05).Conclusion Noninvasive positive pressure ventilation is safe and effective in the treatment of elderly patients with chronic obstructive pulmonary disease and mild pulmonary hypertension.