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呼吸肌肌力的影响

目的探讨与评估家庭无创正压机械通气治疗对稳定期重度慢性阻塞性肺疾病患者呼吸肌肌力的影响。方法将24例应用家庭无创正压机械通气治疗的稳定期重度慢性阻塞性肺疾病患者设为治疗组，同时以进行长时程家庭氧疗的40例稳定期重度慢性阻塞性肺疾病患者作为对照组，分别记录治疗前、治疗后1年两组患者的最大吸气压（MIP）、跨膈压（Pdi）、最大跨膈压（Pdimax）及Pdi／Pdimax、PaCO2、肺功能、6min行走距离（6MWD）、病死率及再住院率等指标。结果两组年龄、性别、慢性阻塞性肺疾病病程、体重指数、PaCO2、PaO2、MIP、Pdi、Pdimax及Pdi／Pdimax、第一秒用力呼气容积占预计值百分比（FEV1％）、第一秒用力呼气容积占用力肺活量比值（FEV1／FVC％）、6MWD和每年住院次数均具可比性（均P〉0.05）。1年后治疗组PaCO2、MIP、Pdi、Pdimax及Pdi／Pdimax、FEV1％、FEV1／FVC％、6MWD、每年住院次数分别为（52±8）mmHg（1mmHg=0．133kPa）、（64±7）cmH2O（1cmH2O=0.098kPa）、（33±5）cmH2O、（101±9）cmH2O、0．31±0．04、（35±4）％、（44±4）％、（272±26）m和（2.6±0.8）次／年，与对照组[（57±6）mmHg、（59±6）cmH2O、（31±4）cmH2O、（84±7）cmH2O、0.35±0.05、（33±3）％、（41±4）％、（212±28）m、（3．7±0.8）次/年]比较均具有统计学意义（均P〈0.05）。治疗组死亡1例（1／24），对照组3例（3／40），两组比较差异无统计学意义（Χ^2=0.00，P〉0.05）。结论长期家庭无创正压机械通气可以有效地提高稳定期重度慢性阻塞性肺疾病患者的呼吸肌肌力及呼吸肌耐力，改善肺通气功能，从而达到更好的长期治疗效果。

Influence of long-term home noninvasive positive pressure ventilation on respiratory muscle strength in patients with stable severe chronic obstructive pulmonary disease

Objective To study the influence of long-term home noninvasive positive pressure ventilation (HNPPV) on respiratory muscle strength in patients with stable severe chronic obstructive pulmonary disease (COPD).Methods Sixty-four patients with stable severe COPD discharged from Huabei Oil-field Hospital,Renqiu,Hebei were divided into two groups,one (n=24) with HNPPV plus conventional therapy,and the other (n=40) with conventional therapy plus long-term oxygen therapy as controls.All parameters were followed-up for one-year and compared for the two groups,including maximal iuspiratory pressure (MIP),transdiaphragmatic pressure (Pdi),maximal transdiaphragmatic pressure (Pdimax),ratio of Pdi/Pdimax,arterial partial pressure of carbon dioxide (PaCO2),forced expiratory volume in one second (FEV1),6-min walking distance (6MWD),mortality and re-hospitalization rate.Results Age,gender,course of the disease,body mass index (BMI),arterial PaCO2,PaO2,MIP,Pdi,Pdiraax,ratio of Pdi/ Pdimax,FEV1,ratio of FEV1/FVC%,6MWD and re-hospitalization rate of the patients between the two groups were all comparable (P>0.05).In one-year follow-up,PaCO2averaged (52±8)mm Hg,MIP (64±7) cm H2O,Pdi (33±5) cm H2O,Pdimax (101±9) cm H2O,Pdi/Pdimax (0.31±0.04),FEV1 (35±4) %,FEV1/FVC% (44±4) %,6MWD (272±26) m and (2.6 ± 0.8) admissions per year in the HNPPV group,significantly different from those in the control group [ (57 ± 6) mm Hg,(59 ± 6) cm H2O,(31±4) cm H2O,(84±7) cm H2O,(0.35±0.05),(33±3)%,(41±4)%,(212±28) m,and (3.7±0.8) admissions per year] (P<0.05).One death was observed in the HNPPV group (1/24) and three in the control group (3/4 0) in one - year follow - up,with no statistically significant difference (X2=0.00,P>0.05).Conclusions Long-term use of HNPPV for patients with stable severe COPD could efficiently improve their respiratory muscle strength and endurance,thus improving their pulmonary ventilation and treatment efficcacy.