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目的观察重度慢性阻塞性肺疾病稳定期长期无创正压通气与长期家庭氧疗的疗效。方法 100例重度慢性阻塞性肺疾病稳定期患者随机分为无创正压机械通气治疗组(36例)和对照组(64例)。随访2年,比较两组患者急性加重次数,住院时间及病死率、血气分析结果、肺功能及6 min行走距离(6MWD),观察治疗后患者症状(咳嗽、咯痰、气短等)。结果治疗2年后治疗组血气指标PaCO2、PaO2及6MWD较前改善,差异有统计学意义(P<0.05);2年内急性加重次数及住院时间减少,差异有统计学意义(P<0.05);对照组以上指标均无改善,差异无统计学意义(P>0.05);两组肺功能指标用力肺活量(FVC)和用力呼气容积(FEV1)均有下降,但治疗组下降更慢,差异有统计学意义(P<0.05);2年后两组以上参数比较差异均有统计学意义(P<0.05);2年后治疗组死亡4例(4/36),对照组死亡10例(10/64),两组比较差异无统计学意义(P>0.05)。结论重度慢性阻塞性肺疾病稳定期患者实施长期家庭无创正压机械通气可以明显减少急性加重次数和住院时间,改善血气指标,减慢肺功能下降速度,提高生活质量。
Objective To observe the long-term non-invasive positive pressure ventilation and long-term home oxygen therapy in patients with severe chronic obstructive pulmonary disease. Methods One hundred patients with stable chronic obstructive pulmonary disease (COPD) were randomly divided into non-invasive positive pressure mechanical ventilation group (36 cases) and control group (64 cases). The patients were followed up for 2 years. The number of acute exacerbations, hospital stay and mortality, blood gas analysis results, lung function and 6MWD distance were compared between the two groups. The symptoms (cough, expectoration, shortness of breath and so on) after treatment were observed. Results After 2 years of treatment, PaCO2, PaO2 and 6MWD in the treatment group were significantly improved (P <0.05). The numbers of acute exacerbations and hospital stay decreased in 2 years (P <0.05). There was no significant difference in the above indexes between the two groups (P> 0.05). Both FVC and FEV1 decreased in the two groups, but the decrease in the treatment group was slower than that in the control group (P <0.05). After 2 years, there were significant differences in the above parameters between the two groups (P <0.05). After 2 years, the death rate of the treatment group was 4 cases (4/36) / 64), no significant difference between the two groups (P> 0.05). Conclusion Long-term home-based noninvasive positive pressure mechanical ventilation can significantly reduce the number of acute exacerbations and hospital stay, improve blood gas indexes, slow down the decline of lung function and improve the quality of life in patients with stable chronic obstructive pulmonary disease.