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背景:药物治疗慢性呼吸衰竭的效果有限;采用无创通气对慢性肺心病慢性呼吸衰竭患者进行干预,可能不失为一种改善其症状和体征的有效措施。目的:观察夜间无创正压通气对高原地区慢性肺心病缓解期慢性呼吸衰竭患者的呼吸肌功能、肺功能的作用。设计:完全随机分组设计,对比观察。单位:解放军第四医院兰州军区呼吸内科中心。对象:选择2002-10/2004-11在解放军第四医院兰州军区呼吸内科中心住院的慢性肺心病缓解期慢性呼吸衰竭患者60例,男38例,女22例。患者均知情同意参加。随机分为2组,治疗组和对照组各30例。方法:①治疗组:采用呼吸机治疗,时间为每晚22:00～次日晨7:00,通气模式为压力支持通气和呼气末正压。在治疗前和治疗5周后测定肺功能、动脉血气、呼吸肌功能和6min步行距离。对照组:病情缓解1周后在出院前测定上述指标,出院后未经任何治疗,5周后复诊测定上述指标。②6min步行距离试验:让患者尽最大努力在20m走廊内行走,完成6min或以呼吸困难不能坚持为止,用计量表测算步行距离。用电脑膈肌功能测定仪测定口腔最大吸气压、最大呼气压后,用气道阻断法测定最大跨膈压。采用血气分析仪测定动脉血氧分压和二氧化碳分压。用电脑肺功能仪测定第1秒用力呼气量占预计值百分比、第1秒用力呼气量占用力肺活量百分比。③组间比较采用t检验,组内比较采用配对t检验。主要观察指标:两组干预前后呼吸肌功能、肺功能、动脉血气和6min步行距离比较。结果:纳入慢性肺心病缓解期慢性呼吸衰竭患者60例均进入结果分析。两组患者干预前动脉血气和肺功能各项指标相近(P>0.05)。干预5周后,动脉血氧分压、第1秒用力呼气量占预计值百分比、第1秒用力呼气量占用力肺活量百分比、最大吸气压、最大呼气压、最大跨膈压和6min步行距离:治疗组治疗后明显高于治疗前和对照组治疗后(P<0.05～0.01),动脉血二氧化碳分压:治疗组治疗后明显低于治疗前和对照组治疗后(P<0.01)。结论:夜间无创正压通气治疗能显著改善高原地区肺心病缓解期慢性呼吸衰竭患者的动脉血气和肺功能,增强呼吸肌力量。
Background: The effect of medication on chronic respiratory failure is limited. Intervention in patients with chronic respiratory failure due to chronic cor pulmonale by noninvasive ventilation may be an effective measure to ameliorate the symptoms and signs of chronic respiratory failure. Objective: To observe the effects of nighttime noninvasive positive pressure ventilation on respiratory muscle function and pulmonary function in chronic respiratory failure patients with chronic pulmonary heart disease in high altitude area. Design: completely randomized design, comparative observation. Unit: PLA Fourth Hospital Lanzhou Military Respiratory Medicine Center. PARTICIPANTS: Sixty patients, including 38 males and 22 females, were enrolled in the remission period of chronic pulmonary heart disease (COPD) admitted to the Respiratory Medicine Center, Lanzhou Military Region, Fourth Hospital of PLA from October 2002 to November 2004. Patients are informed consent to participate. Randomly divided into two groups, the treatment group and the control group of 30 cases. Methods: ① The treatment group: ventilator treatment, the time for each night 22:00 ~ 7:00 the next morning, ventilation mode for pressure support ventilation and positive end expiratory pressure. Pulmonary function, arterial blood gas, respiratory muscle function, and 6-minute walking distance were measured before treatment and after 5 weeks of treatment. Control group: one week after remission, the above indexes were measured before discharge, without any treatment after discharge, and the above indexes were measured after 5 weeks. ② 6min walking distance test: Let the patient do his utmost to walk in the 20m corridor, to complete 6min or breathing difficulties can not adhere to the date, with a meter to measure the walking distance. The maximum diastolic pressure of the oral cavity was measured by computerized diaphragmatic functional analyzer, and the maximum diastolic pressure was measured by airway block after the maximal expiratory pressure. Blood gas analyzer was used to measure arterial partial pressure of oxygen and partial pressure of carbon dioxide. Using computer lung function measured 1 second forced expiratory volume percentage of the expected value, the first second forced expiratory volume occupancy force vital capacity percentage. ③ Comparison between groups using t test, the group was compared using paired t test. MAIN OUTCOME MEASURES: Respiratory muscle function, pulmonary function, arterial blood gas, and 6-minute walking distance were compared between the two groups before and after intervention. Results: Sixty patients with chronic respiratory failure during remission of chronic pulmonary heart disease were involved in the result analysis. The two groups of patients before intervention arterial blood gas and lung function of various indicators (P> 0.05). Intervention after 5 weeks, arterial partial pressure of oxygen, the first second forced expiratory volume percentage of the expected value, the first second forced expiratory volume occupancy force vital capacity percentage, maximum suction pressure, maximum expiratory pressure, maximum diastolic pressure and 6min walk distance: The treatment group after treatment was significantly higher than before treatment and control group after treatment (P <0.05 ~ 0.01), arterial carbon dioxide partial pressure: the treatment group after treatment was significantly lower than before treatment and control group after treatment (P <0.01 ). Conclusion: Nocturnal noninvasive positive pressure ventilation can significantly improve arterial blood gas and lung function, and enhance the strength of respiratory muscles in patients with chronic respiratory failure during remission of pulmonary heart disease in the plateau region.