家庭无创正压机械通气联合呼吸操对稳定期慢性阻塞性肺疾病患者的随机对照研究被引量：4

Randomized controlled trial of home noninvasive positive pressure ventilation plus breathing exercises in patients with stable severe chronic obstructive pulmonary disease

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摘要目的探索与评估家庭无创正压机械通气（HNPPV）联合呼吸操对稳定期重度慢性阻塞性肺疾病（COPD）患者的疗效.方法将56例经住院治疗处于稳定期的重度COPD患者分为呼吸操＋HNPPV组（治疗组）26例和无创呼吸机组（对照组）30例.分别记录治疗前、治疗后2年两组患者的动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、肺功能、6分钟行走距离（6MWD）、呼吸困难分级、辅助呼吸肌评分、年住院次数及病死率等指标.结果治疗前治疗组与对照组的年龄、性别、COPD病程、体质量指数、PaCO2、PaO2、第1秒用力呼气容积占预计值百分比（FEV1%pred）、第1秒用力呼气容积占用力肺活量比值（FEV1/FVC%）、6MWD、呼吸困难分级、辅助呼吸肌评分、每年住院次数均具有可比性.2年后治疗组呼吸困难分级、辅助呼吸肌评分、6MWD、每年住院次数,优于对照组[（1.76±0.52）分vs（2.09±0.57）分、（2.44±0.62）分vs（2.96±0.58）分、（262.64±32.98）m vs（244.25±25.83）m、（2.06±0.85）次/年vs（2.62±0.92）次/年],差异均具有统计学意义（P值均＜0.05）,治疗组死亡1例（1/26）,对照组死亡2例（2/30）,两组病死率比较差异无统计学意义（x2=0.02）.结论长期应用HNPPV联合呼吸操锻炼对稳定期重度COPD患者的康复更加有效. Objective To study the effects of home noninvasive positive pressure ventilation （HNPPV） plus breathing exercises actualized on the patients with stable severe chronic obstructive pulmonary disease （COPD）. Methods Fifty-six patients with stable severe COPD after hospital discharge were randomized divided into 2 groups： the therapy group （n = 26） with breathing exercises and HNPPV,and the control group （ n = 30） with HNPPV. Parameters before and after 2 year follow up observation were compared, which included arterial partial pressure of carbon dioxide （PaCO2）, pulmonary function,6-min walking distance （6MWD）, dyspnea grade, scale for accessory muscle use, hospitalization rates and mortality. Results The age,gender, course of disease, body mass index, arterial PaCO2, PaO2,forced expiratory volume in one second （ FEV1 % pred）, FEV1/FVC%, 6MWD, dyspnea grade, scale for accessory muscle use,and hospitalization rates of the 2 groups were similar. After 2 years,the difference of dyspnea grade,scale for accessory muscle use,6MWD and hospitalization rates in the therapy group was statistically significant compared to the control group[（1. 76±0.52） vs （2.09±0. 57）、（2. 44±0.62） vs（2.96±0.58）、（262.64±32.98） m vs （244. 25±25.83） m、（2.06±0.85） times/year vs （2.62±0.92）times/year] （all P 〈 0.05）. The mortality had no statistically significant difference （1/26, 2/30,respectively, x 2 = 0.02）. Conclusions HNPPV plus breathing exercises with stable severe COPD is effective and safe.

作者刘海涛何敬堂李志娟赵梅星李红张景汪涛

机构地区任丘市华北石油总医院呼吸内科

出处《国际呼吸杂志》 2010年第21期1290-1293,共4页 International Journal of Respiration

关键词肺疾病慢性阻塞性无创正压机械通气家庭机械通气呼吸功能不全高碳酸血症呼吸锻炼 Pulmonary disease, chronic obstructive Noninvasive positive pressure ventilation Home mechanical ventilation Respiratory insufficiency Hypercapnia Breathing exercises

分类号 R563.9 [医药卫生—呼吸系统]

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