| 石建邦,邓林锋,徐非洲,等.无创辅助通气联合肺康复在重度慢性阻塞性肺疾病稳定期患者中的应用价值[J].中国临床保健杂志,2021,24(6):805-809. |
| 无创辅助通气联合肺康复在重度慢性阻塞性肺疾病稳定期患者中的应用价值 |
| The application value of non-invasive assisted ventilation combined with pulmonary rehabilitation in patients with severe chronic obstructive pulmonary disease during the stable stage |
| 投稿时间：2020-10-30 |
| DOI：10.3969/J.issn.1672-6790.2021.06.019 |
| 中文关键词: 肺疾病,慢性阻塞性 康复 无创通气 生活质量 |
| 英文关键词: Pulmonary disease,chronic obstructive Rehabilitation Noninvasive ventilation Quality of life 〖FL |
| 基金项目:江西省卫生计生委科技计划项目(20197100) |
| 作者 | 单位 | E-mail | | 石建邦 | 江西省九江市第一人民医院/南昌大学附属九江医院, 呼吸内科,九江 332000 | shijianbang-dlf@163.com | | 邓林锋 | 江西省九江市第一人民医院/南昌大学附属九江医院,检验科,九江 332000 | | | 徐非洲 | 江西省九江市第一人民医院/南昌大学附属九江医院, 呼吸内科,九江 332000 | | | 张佳秀 | 江西省九江市第一人民医院/南昌大学附属九江医院, 呼吸内科,九江 332000 | | | 吴健卫 | 江西省九江市第一人民医院/南昌大学附属九江医院, 呼吸内科,九江 332000 | |
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| 中文摘要: |
| 目的 探讨无创辅助通气联合肺康复在重度慢性阻塞性肺疾病(COPD)稳定期患者中应用价值。方法 120例稳定期重度COPD患者按区组随机化分为肺康复联合无创辅助通气组(联合组)、无创辅助通气组(无创组)、肺康复组(康复组)、对照组,对照组采取常规药物治疗,联合组、无创组及康复组予以肺康复和(或)无创辅助通气治疗干预16周,评价无创辅助通气及肺康复对重度COPD稳定期患者的临床疗效。结果 联合组动脉血二氧化碳分压(PaCO2)、呼吸困难程度(mMRC)、圣乔治呼吸问卷(SGRQ)及呼吸困难评分和疾病综合评分(BODE指数)均较入组时明显下降,差异均有统计学意义(P值均<0.05)；6 min步行距离(6MWD)较入组时明显提高,差异有统计学意义(P=0.003)；而动脉血氧分压(PaO2)、体重指数(BMI)、第1秒用力呼气量(FEV1)、FEV1/预计值(%)及用力肺活量(FVC)较入组时比较,差异无统计学意义。无创组PaCO2及SGRQ较入组时均有下降,差异均有统计学意义(P值均<0.05)；6MWD较入组时明显提高,差异有统计学意义(P<0.05)；而PaO2、BMI、BODE、mMRC、FEV1、FEV1/预计值(%)及FVC较入组时比较,差异无统计学意义。康复组mMRC及SGRQ较入组时下降,差异均有统计学意义(P值均<0.05)；6MWD较入组时提高,差异有统计学意义(P<0.05)；而PaO2、PaCO2、BMI、BODE、FEV1、FEV1/预计值(%)及FVC较入组时比较,差异无统计学意义。结论 无创辅助通气联合肺康复策略是稳定期重度COPD患者最佳选择,与单纯肺康复或无创辅助通气相比更能改善生活质量、缓解呼吸困难、提高运动耐力及纠正高碳酸血症。 |
| 英文摘要: |
| Objective To investigate the value of noninvasive assisted ventilation combined with pulmonary rehabilitation in patients with severe chronic obstructive pulmonary disease (COPD) during the stable stage.Methods One hundred and twenty patients with stable severe COPD were randomly divided into pulmonary rehabilitation combined with non-invasive assisted ventilation group (combined group),non-invasive assisted ventilation group (non-invasive group),pulmonary rehabilitation group (rehabilitation group),and control goup.The control group was treated with conventional drugs.Combined group,non-invasive group and rehabilitation group were treated with pulmonary rehabilitation and/or non-invasive assisted ventilation intervention for 16 weeksto evaluate the clinical significance of non-invasive assisted ventilation and pulmonary rehabilitation in patients with severe COPD in stable stage.Results The arterial partial pressure of carbon dioxide (PaCO2),dyspnea (mMRC),St.George′s Respiratory Questionnaire (SGRQ),dyspnea score and disease comprehensive score (BODE index) of the combined group were significantly lower than those at the time of entry,and the differences were statistically significant (all P values<0.05);6-minute walking distance (6MWD) was significantly higher than that at entry,and the differences were statistically significant (P=0.003).While the arterial partial pressure of oxygen (PaO2),BMI,FEV1,FEV1/predicted value (%) and forced vital capacity (FVC) were not statistically significant when compared with those at the time of enrollment.PaCO2 and SGRQ in the non-invasive group decreased compared with those at the time of enrollment,and the differences were statistically significant (P<0.05);6MWD was significantly higher than that at enrollment,and the differences were statistically significant (P<0.05).While PaO2,BMI,BODE,mMRC,FEV1,FEV1/expected value(%) and FVC were not statistically significant when compared with those at the time of enrollment.The mMRC and SGRQ in rehabilitation group decreased compared with those at the time of enrollment,and the difference was statistically significant (P<0.05);6MWD was increased compared with that at the time of enrollment,and the difference was statistically significant (P<0.05).There was no statistically significant difference in PaO2,PaCO2,BMI,BODE,FEV1,FEV1/expected value (%) and FVC compared to those at the time of enrollment.Conclusions The strategy of noninvasive assisted ventilation combined with pulmonary rehabilitation is a better choice for patients with severe COPD during the stable phase,which can improve the quality of life,relieve dyspnea,improve exercise endurance and correct hypercapnia better compared with pure pulmonary rehabilitation or noninvasive assisted ventilation. |
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