摘要目的 探讨稳定期合并高碳酸血症的极重度慢性阻塞性肺疾病(COPD)患者应用家庭无创机械通气的疗效.方法将患者分为无创通气组20例,对照组26例,其中两组患者的性别、年龄、病程,吸烟史、肺功能及血气分析指标差异均无统计学意义.随访期为1年,分别测量比较患者在出院时和出院1年后的第1秒用力呼气容积(FEV1),用力肺活量(FVC),匹兹堡睡眠质量指数量表(PSQI)评分、圣·乔治呼吸问卷(SGRQ)评分,动脉血二氧化碳分压(PCO2)、动脉血氧分压(PO2)、pH值,呼吸困难分级和6分钟步行距离(6WMD),并观察患者1年内因急性加重而住院的次数.结果①稳定期合并高碳酸血症的两组极重度COPD患者,其FEV1,FVC、PO2,pH值在治疗前后差异均无统计学意义(P>0.05),但两组患者的PCO2在治疗前后差异有统计学意义(P <0.05),其中无创通气组的PCO2较出院时降低(P<0.05),对照组的PCO2较出院时升高(P<0.05).②两组患者的SGRQ评分差异均有统计学意义(P<0.05).无创通气组治疗1年后的MMRC评分比治疗前有所降低(P <0.05).而对照组差异无统计学意义(P>0.05).对照组患者出院1年的6WMD较出院时明显下降(P<0.05),无创通气组则较出院时差异无统计学意义(P>0.05).两组患者出院1年后的PSQI与出院时相比差异均无统计学意义(P>0.05).③无创通气组经无创通气后其住院次数与1年前相比明显下降(P<0.05),对照组则呈现上升趋势(P<0.05).结论稳定期合并高碳酸血症的极重度COPD患者,长期家庭无创正压通气对患者的肺功能无明显的改善,但是可以降低患者PCO2,一定程度上改善缺氧,提高生活质量,减少住院次数,提高运动耐力,缓解呼吸困难,但对于睡眠质量没有明显的改变.

abstractsObjective To detect the effection of non-invasive positive pressure ventilation in the severe chronic obstructive pulmonary disease (COPD) patients with hypercapnemia. Methods The severe COPD patients compared with hypercapnemia were divided into two groups: the mechanical ventilation group( n = 20), patients accept long-term domiciliary non-invasive positive pressure ventilation. The control group( n = 26). Followed up a year. The FEV1, FVC, SGRQ scores, PSQI, arterial gasometry,MMRC dyspnea scale were carried out in the day of hospital discharge and a year after hospital diacharge.mechanical ventilation group was no statistically significant different compared to the control group in the severe COPD patients with hypercapnemia( P >0.05), however, the PCO2 were statistically significant different( P <0. 05) between the mechanical ventilation group and control group. The PCO2 in the mechanical ventilation group decreased significantly after a year ( P <0.05). And the PCO2 in the control was statistically different compared to the control group in the severe COPD patients with hypereapnemia ( P <0. 05). The MMRC dyspnea scale in the mechanical ventilation group decreased after a year ( P <0.05), while it was no statistically significant different in the control group. The 6-MWD in the control group decreased after a year (P<0.05), while it was no statistically significant different in the mechanical ventilation group. The PSQI scores in the mechanical ventilation group was no statistically significant different compared to the control group in the severe COPD patients with hypereapnemia ( P>a year ( P< 0.05 ), while it increased significantly after a year in the control group ( P < 0.05 ).Conclusions Long-term domiciliary non-invasive positive pressure ventilation have no benefit for the lung faction for the stable COPD patients with chronic hypercapnie, But can reduce the artery PCO2. Releaving hypoxia. Improving life statues. Reducing the frequency of hospitalization. Improving the exercise tolerance. No obviously effect for PSQI scores.