CAJ | 학술논문

目的探讨长期家庭无创辅助通气对稳定期慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者的治疗效果.方法确诊稳定期COPD合并Ⅱ型呼吸衰竭患者共78例,按患者意愿分为治疗组26例和对照组52例,对照组予以常规治疗,包括吸入沙美特罗/氟替卡松+长期家庭氧疗(LTOT);治疗组在常规治疗基础上加用无创辅助通气治疗,每日6～8h,疗程12个月,观察两组血气分析指标[pH值、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)]、肺功能指标[第1秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1％)]、6 min步行试验(6-MWT)距离、圣乔治呼吸问卷(SGRQ)评分及急性发作住院次数.结果随访12个月,治疗组无一例因急性发作行气管插管,无一例死亡.对照组有5例因急性发作行气管插管、有创机械通气,其中1例死亡.治疗后两组肺功能指标(FEV1、FEV1％)较治疗前均有改善(P＜0.05).但治疗组治疗后FEV1、FEV1％显著高于同期对照组(P＜0.05).治疗组治疗后血气分析指标(pH值、PaCO2、PaO2)较治疗前显著改善(P＜0.05).对照组治疗后PaO2较治疗前显著改善(P＜0.05),但对照组治疗后pH值、PaCO2与治疗前比较差异无统计学意义(P＞0.05).两组患者治疗后6-MWT距离、SGRQ评分较治疗前均有改善,差异有统计学意义(P＜0.05),治疗组治疗后6-MWT距离显著高于同期对照组、SGRQ评分显著低于同期对照组,差异均有统计学意义(P＜0.05).随访12个月,治疗组平均每人急性发作次数(0.84±0.16)次,对照组(1.49±0.78)次,差异有统计学意义(t=-3.65,P＜0.05).结论家庭无创辅助通气治疗可以改善稳定期COPD合并Ⅱ型呼吸衰竭患者的肺功能、血气分析,增加运动耐量,提高生活质量,减少急性发作次数及插管率.
목적 탐토장기가정무창보조통기대은정기만성조새성폐질병(COPD)합병Ⅱ형호흡쇠갈환자적치료효과.방법 학진은정기COPD합병Ⅱ형호흡쇠갈환자공78례,안환자의원분위치료조26례화대조조52례,대조조여이상규치료,포괄흡입사미특라/불체잡송+장기가정양료(LTOT);치료조재상규치료기출상가용무창보조통기치료,매일6～8h,료정12개월,관찰량조혈기분석지표[pH치、동맥혈이양화탄분압(PaCO2)、동맥혈양분압(PaO2)]、폐공능지표[제1초용력호기용적(FEV1)、FEV1점예계치백분비(FEV1％)]、6 min보행시험(6-MWT)거리、골교치호흡문권(SGRQ)평분급급성발작주원차수.결과 수방12개월,치료조무일례인급성발작행기관삽관,무일례사망.대조조유5례인급성발작행기관삽관、유창궤계통기,기중1례사망.치료후량조폐공능지표(FEV1、FEV1％)교치료전균유개선(P＜0.05).단치료조치료후FEV1、FEV1％현저고우동기대조조(P＜0.05).치료조치료후혈기분석지표(pH치、PaCO2、PaO2)교치료전현저개선(P＜0.05).대조조치료후PaO2교치료전현저개선(P＜0.05),단대조조치료후pH치、PaCO2여치료전비교차이무통계학의의(P＞0.05).량조환자치료후6-MWT거리、SGRQ평분교치료전균유개선,차이유통계학의의(P＜0.05),치료조치료후6-MWT거리현저고우동기대조조、SGRQ평분현저저우동기대조조,차이균유통계학의의(P＜0.05).수방12개월,치료조평균매인급성발작차수(0.84±0.16)차,대조조(1.49±0.78)차,차이유통계학의의(t=-3.65,P＜0.05).결론 가정무창보조통기치료가이개선은정기COPD합병Ⅱ형호흡쇠갈환자적폐공능、혈기분석,증가운동내량,제고생활질량,감소급성발작차수급삽관솔.
Objective To investigate the clinical effect of long-term home non-invasive assisted ventilation in stable chronic obstructive pulmonary disease (COPD) combined with type Ⅱ respiratory failure.Methods Seventy-eight patients with stable COPD combined with type Ⅱ respiratory failure were divided into treatment group (26 cases) and control group (52 cases).Patients in control group were given conventional treatment,including inhaled salmeterol/fluticasone plus long-term home oxygen therapy (LTOT).Patients in treatment group on the basis of conventional treatment were given non-invasive assisted ventilation therapy for 6-8 hours a day,and the course was 12 months.Blood gas analysis index [pH,arterial blood carbon dioxide partial pressure (PaCO2),arterial blood oxygen partial pressure (PaO2)],pulmonary function index [forced expiratory volume in 1 second (FEV1),FEV1 percentage of expected value (FEV1％)],6 min walk test (6-MWT) distance,St George's respiratory questionnaire (SGRQ) and acute episodes.Results After 12 months'follow-up,there was no endotracheal intubation and dead patients in treatment group.Five patients had acute trachea intubation and invasive mechanical ventilation,and 1 case died in the control group.The index of pulmonary function (FEV1,FEV1％) in two groups after treatment was improved compared with that before treatment (P＜ 0.05).But FEV1 and FEV1％ over the same period in treatment group after treatment was higher than that in control group (P ＜ 0.05).The blood gas analysis indicators (pH,PaCO2,PaO2) in treatment group after treatment were improved compared with that before treatment (P ＜0.05).PaO2 in control group after treatment was improved,compared with that before treatment (P＜ 0.05),but there was no significant difference in control group in pH and PaCO2 levels before and after treatment (P ＞0.05).After treatment 6-MWT distance,and SGRQ scores were improved,compared with that before treatment (P ＜ 0.05),6-MWT from the same period in treatment group after treatment was higher than that in control group,and SGRQ scores was lower than that in control group during this period (P ＜ 0.05).There was significant difference in average acute episodes between treatment group and control group [(0.84 ± 0.16) times vs.(1.49 ± 0.78) times,t =-3.65,P ＜ 0.05].Conclusion Home non-invasive assisted ventilation treatment can improve blood gas analysis and pulmonary function in patients of COPD combined with type Ⅱ respiratory failure of stationary phase,increase exercise tolerance,improve the quality of life,and reduce the number of acute episodes and intubation rate.