CAJ | 학술논문

目的观察长期无创正压通气(NIPPV)对稳定期严重慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者临床疗效及血清基质金属蛋白酶9(MMP-9)的影响.方法选择80例处于稳定期的严重COPD合并呼吸衰竭患者,按其能否耐受并接受长期NIPPV治疗分为实验组和对照组,两组患者均给予吸氧、口服茶碱缓释片、吸入噻托溴铵等治疗,实验组在此基础上加用双水平NIPPV治疗1年.观察两组患者治疗前后圣乔治呼吸问卷评分(SGRQ评分)、呼吸困难评分(MMRC评分)、六分钟行走距离(6-MWD)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、第1秒用力呼气容积占预计值百分比(FEV1％ pred)及血清MMP-9等变化,并记录两组患者上1年及治疗后1年内急性发作及住院情况.结果治疗前后实验组SGRQ评分、MMRC评分、6-MWD、PaO2、PaCO2、FEV1％ pred、血清MMP-9分别是(63.60±3.92)分比(51.93±3.77)分、(3.65±0.48)分比(2.43±0.50)分、(158.85±6.39)m比(248.00±9.32)m、(56.98±1.63)mm Hg比(66.58±2.23)mm Hg、(60.58±2.89) mm Hg比(51.55±2.28) mm Hg、(38.68±3.17)比(42.05±3.11)、(182.85±6.62)μg/L比(170.93±6.51)μg/L,治疗前后对照组SGRQ评分、MMRC评分、6-MWD、PaO2、PaCO2、FEV1％ pred、血清MMP-9分别是(64.40±4.33)分比(53.75±3.73)分、(3.73±0.45)分比(2.83±0.39)分、(156.50±5.88)m比(211.43±7.53)m、(56.80±1.57)mm Hg比(62.58±1.91) mm Hg、(59.90±3.49) mm Hg比(55.98±3.36)mm Hg、(38.85±2.77)比(40.80±3.16)、(180.60±5.23) μg/L比(172.83±5.22)μg/L,实验组改善优于对照组(P＜0.05或P＜0.01)；急性发作次数、住院天数等明显减少,实验组优于对照组.结论严重COPD合并呼吸衰竭患者稳定期长期NIPPV可明显提高患者生活质量,降低血清MMP-9水平.
목적 관찰장기무창정압통기(NIPPV)대은정기엄중만성조새성폐질병(COPD)합병호흡쇠갈환자림상료효급혈청기질금속단백매9(MMP-9)적영향.방법 선택80례처우은정기적엄중COPD합병호흡쇠갈환자,안기능부내수병접수장기NIPPV치료분위실험조화대조조,량조환자균급여흡양、구복다감완석편、흡입새탁추안등치료,실험조재차기출상가용쌍수평NIPPV치료1년.관찰량조환자치료전후골교치호흡문권평분(SGRQ평분)、호흡곤난평분(MMRC평분)、륙분종행주거리(6-MWD)、동맥혈양분압(PaO2)、동맥혈이양화탄분압(PaCO2)、제1초용력호기용적점예계치백분비(FEV1％ pred)급혈청MMP-9등변화,병기록량조환자상1년급치료후1년내급성발작급주원정황.결과 치료전후실험조SGRQ평분、MMRC평분、6-MWD、PaO2、PaCO2、FEV1％ pred、혈청MMP-9분별시(63.60±3.92)분비(51.93±3.77)분、(3.65±0.48)분비(2.43±0.50)분、(158.85±6.39)m비(248.00±9.32)m、(56.98±1.63)mm Hg비(66.58±2.23)mm Hg、(60.58±2.89) mm Hg비(51.55±2.28) mm Hg、(38.68±3.17)비(42.05±3.11)、(182.85±6.62)μg/L비(170.93±6.51)μg/L,치료전후대조조SGRQ평분、MMRC평분、6-MWD、PaO2、PaCO2、FEV1％ pred、혈청MMP-9분별시(64.40±4.33)분비(53.75±3.73)분、(3.73±0.45)분비(2.83±0.39)분、(156.50±5.88)m비(211.43±7.53)m、(56.80±1.57)mm Hg비(62.58±1.91) mm Hg、(59.90±3.49) mm Hg비(55.98±3.36)mm Hg、(38.85±2.77)비(40.80±3.16)、(180.60±5.23) μg/L비(172.83±5.22)μg/L,실험조개선우우대조조(P＜0.05혹P＜0.01)；급성발작차수、주원천수등명현감소,실험조우우대조조.결론 엄중COPD합병호흡쇠갈환자은정기장기NIPPV가명현제고환자생활질량,강저혈청MMP-9수평.
Objective To investigate the clinical efficacy of the treatment with long-term NIPPV in patients with stable severe COPD complicated with respiratory failure,and the impacting on serum levels of MMP-9.Methods We selected prospectively 80 outpatients of stable severe COPD complicated with respiratory failure which were divided into two groups (experimental and control group,each group 40)according to their ability to tolerate and accept the long-term NIPPV treatment,two groups of patients were given oxygen therapy,slow-release oral theophylline,and inhalation of tiotropium for one year,and added to 1 year NIPPV therapy in experimental group.The outcomes measured included the followings:SGRQ score,MMRC score,6-MWD,PaO2,PaCO2,FEV1 ％pred,the serum levels of MMP-9 and the rate of acute exacerbations of COPD and hospital days in last 1 year and following 12 months.Results After 1year,the differences of SGRQ score,MMRC score,6-MWD,PaO2,PaCO2,FEV1％ pred,MMP-9 in the experimental group [(63.60 ± 3.92) scores vs (51.93 ± 3.77) scores,(3.65 ± 0.48) scores vs (2.43±0.50) scores,(158.85±6.39) mvs (248.00±9.32) m,(56.98±1.63) mm Hg vs (66.58±2.23) mm Hg,(60.58±2.89) mm Hg vs (51.55±2.28) mm Hg,(38.68±3.17) vs (42.05±3.11),(182.85±6.62) μg/L vs (170.93 ± 6.51) μg/L] were statistically significant compared to the control group [(64.40±4.33) scores vs (53.75±3.73) scores,(3.73± 0.45) scores vs (2.83±0.39) scores,(156.50±5.88) m vs (211.43±7.53) m,(56.80±1.57) mm Hg vs (62.58±1.91) mm Hg,(59.90±3.49) mm Hg vs (55.98±3.36) mm Hg,(38.85±2.77) vs (40.80±3.16),(180.60±5.23) μg/L vs(172.83±5.22) μg/L](all P ＜0.05 or P ＜0.01),the rate of acute exacerbations COPD and hospital days were decreased,and the experimental group excelled.Conclusions Our study indicates that longterm NIPPV could significantly improve the living conditions of the patients with severe stable COPD complicated with respiratory failure,lower the serum levels of MMP-9.