昼夜无创正压通气在慢性阻塞性肺疾病稳定期肺康复治疗中的疗效研究
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摘要
目的研究昼夜无创正压通气在慢性阻塞性肺疾病(COPD)稳定期病人肺康复治疗中的治疗效果。方法将2015～2016年在本院呼吸科确诊的68例稳定期COPD病人随机分为日间无创组、夜间无创组和锻炼组3组,6个月后比较各组病人在生活质量、呼吸困难、运动耐量及肺功能方面的差异。结果 (1)干预前,各组间性别、年龄、吸烟、体质量指数(BMI)、COPD评估测试(CAT)评分、改良的英国医学委员会呼吸困难量表(m MRC)评分、6 min步行距离(6MWD)、第1秒用力呼气容积占预计值的百分比(FEV1%pred)等方面比较,差异均无统计学意义。(2)干预后,3组的CAT评分、m MRC评分、6MWD、FEV1%pred均较干预前显著改善(P<0. 05)。(3)与锻炼组相比,干预后日间无创组及夜间无创组的CAT评分、m MRC评分、6MWD均显著改善(P<0. 05);与日间无创组相比,干预后夜间无创组CAT评分、m MRC评分、6MWD差异无统计学意义(P>0. 05)。(4)干预后3组FEV1%pred差异均无统计学意义(P>0. 05)。结论 COPD稳定期病人肺康复治疗中联合昼、夜使用无创正压通气较单纯康复锻炼更能显著提高其生活质量,改善呼吸困难、运动耐量。
Objective To study the effects of non-invasive positive pressure ventilation at daytime or nighttime in the treatment of stable chronic obstructive pulmonary disease( COPD). Methods Sixty-eight patients with stable COPD from January 2015 to December 2016 in our hospital were randomly divided into three groups,including daytime noninvasive group,nocturnal noninvasive group and exercise group. After six months,the differences in quality of life,dyspnea,exercise tolerance and lung function were compared among the groups. Results( 1) There was no significant difference in gender,age,smoking,body mass index( BMI),COPD assessment test questionnaire( CAT) score,modified British Medical Research Council Respiratory Questionnaire( m MRC) score,6-minute walk distance( 6 MWD)and the percentage of predicted forced expiratory volume in one second( FEV1%pred) among the three groups.( 2) The CAT score,m MRC score,6 MWD and FEV1%pred of the three groups were significantly improved after intervention( P<0. 05).( 3) Compared with exercise group,the CAT score,m MRC score and 6 MWD of daytime noninvasive group and nocturnal noninvasive group were significantly improved after intervention( P<0. 05),but there was no significant difference in the CAT score,m MRC score and6 MWD between daytime noninvasive group and nocturnal noninvasive group( P>0. 05).( 4) There was no significant difference in FEV1% pred between the three groups after intervention( P> 0. 05).Conclusions Non-invasive positive pressure ventilation at daytime or nighttime can significantly improve the quality of life,dyspnea and exercise tolerance of patients with stable COPD.
Objective To study the effects of non-invasive positive pressure ventilation at daytime or nighttime in the treatment of stable chronic obstructive pulmonary disease( COPD). Methods Sixty-eight patients with stable COPD from January 2015 to December 2016 in our hospital were randomly divided into three groups,including daytime noninvasive group,nocturnal noninvasive group and exercise group. After six months,the differences in quality of life,dyspnea,exercise tolerance and lung function were compared among the groups. Results( 1) There was no significant difference in gender,age,smoking,body mass index( BMI),COPD assessment test questionnaire( CAT) score,modified British Medical Research Council Respiratory Questionnaire( m MRC) score,6-minute walk distance( 6 MWD)and the percentage of predicted forced expiratory volume in one second( FEV1%pred) among the three groups.( 2) The CAT score,m MRC score,6 MWD and FEV1%pred of the three groups were significantly improved after intervention( P<0. 05).( 3) Compared with exercise group,the CAT score,m MRC score and 6 MWD of daytime noninvasive group and nocturnal noninvasive group were significantly improved after intervention( P<0. 05),but there was no significant difference in the CAT score,m MRC score and6 MWD between daytime noninvasive group and nocturnal noninvasive group( P>0. 05).( 4) There was no significant difference in FEV1% pred between the three groups after intervention( P> 0. 05).Conclusions Non-invasive positive pressure ventilation at daytime or nighttime can significantly improve the quality of life,dyspnea and exercise tolerance of patients with stable COPD.
引文
[1] Vogelmeier CF,Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis,management,and prevention of chronic obstructive lung disease 2017 report. Gold executive summary[J]. Am J Respir Crit Care Med,2017,195(5):557-582.
[2] Mannino DM,Buist AS. Global burden of COPD:risk factors,prevalence,and future trends[J]. Lancet,2007,370(9589):765-773.
[3] Kohnlein T,Windisch W,Kohler D,et al. Non-invasive positive pressure ventilation for treatment of severe stable chronic obstructive pulmonary disease:a prospective,multicentre,randomised,controlled clinical trial[J]. Lancet Respir Med,2014,2(9):698-705.
[4] Ambrosino N,Cigni P. Non invasive ventilation as an additional tool for exercise training[J]. Multidiscip Respir Med,2015,10(1):14-20.
[5] Hardinge M,Annandale J,Bourne S,et al. British Thoracic Society guidelines for home oxygen use in adults[J].Thorax,2015,70(Suppl 1):i1-i43.
[6] ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement:guidelines for the six minute walk test[J]. Am J Respir Crit Care Med,2002,166(1):111-117.
[7] Struik FM,Sprooten RT,Kerstjens HA,et al. Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure:a randomised,controlled,parallel-group study[J].Thorax,2014,69(9):826-834.
[8]周露茜,黎晓莹,李允,等.呼吸肌锻炼联合无创正压通气在稳定期重度慢性阻塞性肺疾病患者中的应用[J].中国实用内科杂志,2017,37(4):330-333.
[9] Bolton CE,Singh SJ,Walker PP,et al. Commentary:the British Thoracic Society guideline on pulmonary rehabilitation in adults[J]. Thorax,2013,68(9):887-888.
[2] Mannino DM,Buist AS. Global burden of COPD:risk factors,prevalence,and future trends[J]. Lancet,2007,370(9589):765-773.
[3] Kohnlein T,Windisch W,Kohler D,et al. Non-invasive positive pressure ventilation for treatment of severe stable chronic obstructive pulmonary disease:a prospective,multicentre,randomised,controlled clinical trial[J]. Lancet Respir Med,2014,2(9):698-705.
[4] Ambrosino N,Cigni P. Non invasive ventilation as an additional tool for exercise training[J]. Multidiscip Respir Med,2015,10(1):14-20.
[5] Hardinge M,Annandale J,Bourne S,et al. British Thoracic Society guidelines for home oxygen use in adults[J].Thorax,2015,70(Suppl 1):i1-i43.
[6] ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement:guidelines for the six minute walk test[J]. Am J Respir Crit Care Med,2002,166(1):111-117.
[7] Struik FM,Sprooten RT,Kerstjens HA,et al. Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure:a randomised,controlled,parallel-group study[J].Thorax,2014,69(9):826-834.
[8]周露茜,黎晓莹,李允,等.呼吸肌锻炼联合无创正压通气在稳定期重度慢性阻塞性肺疾病患者中的应用[J].中国实用内科杂志,2017,37(4):330-333.
[9] Bolton CE,Singh SJ,Walker PP,et al. Commentary:the British Thoracic Society guideline on pulmonary rehabilitation in adults[J]. Thorax,2013,68(9):887-888.