CAJ | 학술논문

目的：探讨长期无创正压通气（ NIPPV）治疗重度稳定期COPD合并慢性呼吸衰竭患者的临床疗效。方法选择2011年1月至2013年1月处于稳定期的重度COPD患者60例，随机分为NIPPV组和对照组，每组30例，对比两组患者在随访1年内COPD急性发作次数及住院天数；比较两组治疗后动脉血气分析pH值、PaO2、PaCO2及肺功能；比较两组患者治疗前后圣乔治问卷评分（ SGRQ评分）、呼吸困难评分（ MMRC评分）、6 min步行试验（6-MWT）的变化。结果 NIPPV组患者在随访1年内急性发作次数和住院天数分别为（1.0±1.0）次、（14.0±4.0）d，对照组为（5.0±1.0）次、（26.0±7.0）d，NIPPV组少于对照组，差异有统计学意义（P＜0.01）；两组患者治疗后动脉血气分析显示，pH值及PaO2均较治疗前明显提高，PaCO2较治疗前下降，但NIPPV组优于对照组，差异有统计学意义（P＜0.01）；肺功能检测显示，两组患者FEV1％均较治疗前提高，NIPPV组效果更优，差异有统计学意义（P＜0.05）；两组患者治疗1年后生活质量有所改善，其中两组SGRQ评分及MMRC呼吸困难评分均较治疗前下降，6-MWT较前提高，但NIPPV组明显优于对照组，差异具有统计学意义（ P＜0.01）。结论重度稳定期COPD合并慢性呼衰患者长期使用NIPPV治疗，效果确切，可以有效改善患者高碳酸血症，提高运动耐力，改善生活质量。
목적：탐토장기무창정압통기（ NIPPV）치료중도은정기COPD합병만성호흡쇠갈환자적림상료효。방법선택2011년1월지2013년1월처우은정기적중도COPD환자60례，수궤분위NIPPV조화대조조，매조30례，대비량조환자재수방1년내COPD급성발작차수급주원천수；비교량조치료후동맥혈기분석pH치、PaO2、PaCO2급폐공능；비교량조환자치료전후골교치문권평분（ SGRQ평분）、호흡곤난평분（ MMRC평분）、6 min보행시험（6-MWT）적변화。결과 NIPPV조환자재수방1년내급성발작차수화주원천수분별위（1.0±1.0）차、（14.0±4.0）d，대조조위（5.0±1.0）차、（26.0±7.0）d，NIPPV조소우대조조，차이유통계학의의（P＜0.01）；량조환자치료후동맥혈기분석현시，pH치급PaO2균교치료전명현제고，PaCO2교치료전하강，단NIPPV조우우대조조，차이유통계학의의（P＜0.01）；폐공능검측현시，량조환자FEV1％균교치료전제고，NIPPV조효과경우，차이유통계학의의（P＜0.05）；량조환자치료1년후생활질량유소개선，기중량조SGRQ평분급MMRC호흡곤난평분균교치료전하강，6-MWT교전제고，단NIPPV조명현우우대조조，차이구유통계학의의（ P＜0.01）。결론중도은정기COPD합병만성호쇠환자장기사용NIPPV치료，효과학절，가이유효개선환자고탄산혈증，제고운동내력，개선생활질량。
Objective To investigate the clinical effect of long-term non-invasive positive pressure ventilation ( NIPPV) on stable chronic obstructive pulmonary disease ( COPD) complicated with chronic respiratory failure ( CRF) . Methods From January 2011 to January 2013, 60 patients with severe COPD at stable stages complicated with CRF were randomly divided into two groups (the NIPPV group and the control group).The NIPPV group (n=30) were treated with NIPPV based on conventional therapy, while the control group ( n=30) were treated with conventional therapy.One year after treatment, PaO2, PaCO2, 6-minutes walk test (6-MWT) and St George’s respiratory questionnaire(SGRQ) were detected in the two groups.Results After 1 year, the frequency of acute exacerbations of COPD and hospital stay days were significantly decreased in the NIPPV group than that in the control group.The value of arterial blood gas improved va-riously than before,but the NIPPV group was better than the control group.The lung function analysis showed FEV1%in-crease in two groups, but the NIPPV group was better than the control group.After 1 year treatment the lives of patients in two groups get better, the value of SGRQ, MMRC decreased than before and 6-MWT improved, the NIPPV group was bet-ter than the control group, the differences was statistically significant (P<0.01).Conclusions For patients with severe COPD at stable stage complicated with CRF, NIPPV can significantly improve the quality of life and reduce hypercapnia.