无创正压通气对老年COPD相关肺动脉高压患者的治疗作用

目的探讨无创正压通气对老年慢性阻塞性肺疾病（COPD）相关肺动脉高压（PH）患者的治疗作用。方法人选研究对象为上海市浦东新区公利医院呼吸内科病房2012年1月-2013年6月入院的80例老年慢性阻塞性肺疾病急性加重（AECOPD）患者，所有患者人院后超声心动图检查肺动脉收缩压（PASP）均〉50mmHg，人院后给予抗感染、解痉、平喘、祛痰等治疗。80例患者中男46例，女34例，年龄中位数为70．2岁，随机分为两组，每组40例。A组给予无创正压通气治疗，B组给予尼可刹米治疗。A、B两组患者人院后测定动脉血气、血常规及血清超敏C反应蛋白，10d复查上述指标，比较A、B两组间治疗前后PASP、动脉血pH值、PaO2、PaCO2、氧合指数（PaO2／FiO2）、血白细胞总数、血清超敏C反应蛋白等相关指标的差异，计算A、B两组治疗前后PASP与动脉血pH值、PaO2、PaCO2、PaO2／FiO2、血白细胞总数、血清超敏c反应蛋白的相关系数。结果治疗前A、B两组PASP、动脉血pH值、PaO2、PaCO2、PaO2／FiO2、血白细胞总数、血清超敏C反应蛋白等相关指标均无统计学意义（P均〉0．05）；A组治疗后PASP平均为（36．4±6．1）mmHg，明显低于B组治疗后的（46．8±8．5）mmHg（P〈0．05），A组治疗后动脉血pH值（7．40±0．05）、PaO2（86．3±12．1）mmHg、PaO2／FiO2（408．3±58．2）均明显高于B组治疗后的pH值（7．37±0．09）、Pa02（64．3±7．4）mmHg、Pa02／FiO2（316．5±43．4）（P均〈0．05），A组治疗后动脉血PaC02（46．3±9．5）mmHg明显低于B组治疗后的PaC02（66．4±13．1）mmHg（P〈0．05），治疗后A、B两组血白细胞总数、血清超敏C反应蛋白等相关指标差异均无统计学意义（P均〉0．05）；治疗前后两组PASP与动脉血pH值、PaO2及PaO2／FiO2均呈负相关性，与动脉血PaCO2、血白细胞总数及血清超敏C反应蛋白均呈正相关性。结论无创正压通气通过纠正老年AECOPD患者低氧血症及呼吸性酸中毒、减轻二氧化碳潴留，从而有效降低PASP。

Therapeutic Effect of Noninvasive Positive Pressure Ventilation for Senile COPD Patients with Pulmonary Arterial Hypertension

Objective To investigate the therapeutic effect of noninvasive positive pressure ventilation for senile COPD patients with pulmonary arterial hypertension. Methods 80 cases of senile AECOPD patients whose pulmonary arterial systolic pressure were~50 mmHg in ultrasonic cardiograms were admitted into the respiratory wards of Gongli hospital from January 2012 to June 2013. The subjects consisted of 46 males and 34 females and were randomly divided into group A that was given with noninvasive positive pressure ventilation and group B that was given with nikethamide, with 40 each and the median age of 70.2 years. The arterial blood gas analysis, blood routine and serum hypersensitive C-reactive were detected at the admission and 10 days thereafter. The pulmonary arterial systolic pressure, arterial blood pH, PaO2, PaCO2, oxygenation index （PaO2/FiO2）, total number of white blood cells and serum hypersensitive C-reactive protein before and after the treatment were compared. ResultsThere was no statistical difference about the pulmonary arterial systolic pressure, arterial blood pH, PaO2, PaCO2, oxygenation index （PaO2/FiO2 ）, white blood cells and serum hypersensitive C-reactive protein before the treatment between group A and group B. The average pulmonary arterial systolic pressure of Group A （36.4±6.1） mmHg was significantly lower than that of group B （46.8±8.5） mmHg （P〈0.05）. The arterial blood pH （7.40±0.05）, PaO2 （86.3±12. 1） mmHg and PaO2/FiO2 （408. 3±58.2） of group A were respectively and significantly higher than those of group Bof （7.37±0.09）, （64.3±7.4） mmHg and （316.5±43.4）, respectively （P〈0.05）. The arterial blood PaCO2 of group A （46.3±9.5） mmHg was significantly lower than that of group B （66.4±13. 1） mmHg after the treatment （P〈0.05）. There was no statistical difference in the total number of white blood cells and serum hypersensitive C-reactive protein between group A and group B after the treatment （P〉0. 05）. The pulmonary arterial systolic pressure was negatively correlated with the arterial blood pH value, PaO2 and PaO2/FiO2 but positively correlated with the arterial blood PaCO2, the total number of white blood cells and serum hypersensitive C-reactive protein in both groups. Conclusion Noninvasive positive pressure ventilation can effectively lower the pulmonary arterial systolic pressure by means of correcting and alleviating hypoxemia, respiratory acidosis and carbon dioxide retention in senile patients with AECOPD.