慢性阻塞性肺病稳定期并慢性呼吸衰竭患者家庭无创正压通气治疗的研究.doc

慢性阻塞性肺病稳定期并慢性呼吸衰竭患者家庭无创正压通气治疗的研究 　　作者：李黎　　作者单位：山东省青岛市中心医院, 山东 青岛 266042 　　【摘要】 研究慢性阻塞性肺痰病(Chronic obstructive pulmonary disease, COPD) 稳定期并慢性呼吸衰竭患者家庭使用无创正压通气的疗效。方法：慢性阻塞性肺病稳定期并慢性呼吸衰竭患者使用无创双水平气道正压通气, 与长期家庭氧疗患者比较在治疗的1 年中的急性加重次数、住院次数、住院时间、住院费用以及6min行走距离、圣o乔治呼吸量表评分、血气指标和肺功能参数的变化。结果：慢性阻塞性肺病稳定期并慢性呼吸衰竭患者家庭使用正压无创通气后, PaCO2、HCO3-和圣o乔治呼吸评分降低, pH、PaO2 和6min行走距离增加与氧疗组相比, 急性加重次数、住院次数、住院费用减少, PaCO2和圣o乔治呼吸评分也明显改善。结论：家庭无创正压通气是治疗慢性阻塞性肺病稳定期并慢性呼吸衰竭患者积极和有效的治疗措施。 　　【关键词】 慢性阻塞性肺病,无创正压通气,吸衰竭 　　Abstract:Objective: To ascertain the clinical value of home non-invasive Positive Pressure(NIPPV) ventilation in patients with stable-phase chronic obstructive pulmonary disease (COPD) and type Ⅱ respiratory failure. Methods：Stable COPD patients complicated by type II respiratory failure received bi-level positive airway pressure ventilation. The frequency of acute exacerbation ，admission times, admission expending ,the changes of 6 minutes walk distance, StoGeorges respiratory questionnaire score, blood gas analysis, and pulmonary function results were compared in these patients with those received long term oxygen therapy.Results：After one year home non-invasive positive pressure ventilation, PaCO2，HCO3- and St.Georges respiratory questionnaire score were decreased, while pH, PaO2 and 6-minutes walk distance were increased. Compared with patients received long term oxygen therapy, PaCO2 and St.Georges respiratory questionnaire score were greatly ameliorated, and the frequency of acute exacerbation,admission times and admission expending declined. Conclusion：Home non-invasive positive pressure ventilation will do good to COPD patients with hypercapnic respiratory failure during stable phase. 　　Key words: Chronic obstructive pulmonary disease; Non-invasive positive pressure ventilation; Respiratory failure 　　无创正压通气(non-invasive positive pressure ventilation ,NIPPV)对慢性阻塞性肺病(Chronic obstructive pulmonary disease, COPD)患者急性加重合并呼吸衰竭的治疗效果很好，相当多的病人可避免有创机械通气。严重的COPD 患者在缓解期也常存在Ⅱ型呼吸衰竭, 推测