老年慢性阻塞性肺疾病合并呼吸衰竭患者居家使用无创正压通气的疗效

Efficacy of noninvasive positive pressure ventilation at home in the elderly chronic obstructive pulmonary disease patients accompanied with respiratory failure

摘要:

目的 探讨老年慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者应用家庭无创正压通气(NPPV)的疗效及依从性。方法 选取2016年1月至2017年12月成都理工大学医院内科治疗好转出院的老年COPD合并呼吸衰竭患者100例,按随机数表法分为观察组和对照组,各50例。对照组患者居家给予常规治疗,包括祛痰、清理呼吸道、消痉抑喘、抗感染、长期吸氧。观察组在对照组基础上,加NPPV治疗。随访1年,记录并比较2组患者治疗前后住院情况、生活质量、呼吸困难程度、6-min步行测试(6MWT)、肺功能和动脉血气指标,以及依从性、不良事件发生情况。其中生活质量评价采用SF-36量表,呼吸困难程度采用圣乔治问卷。采用SPSS 21.0统计软件对数据进行分析。根据数据类型,组间比较采用t检验或χ²检验。结果 随访1年,观察组和对照组患者分别住院(13.33±2.54)和(14.32±3.41)d,住院费用分别为(1.57±0.15)万元和(2.12±0.26)万元,2组患者住院时间比较差异无统计学意义(t=1.646,P>0.05),但住院费用比较差异有统计学意义(t=12.956,P<0.05)。与治疗前比较,治疗后2组患者生活质量评分、呼吸困难评分、6MWT、第1秒用力呼气容积(FEV1)、动脉氧分压(PaO₂)和动脉二氧化碳分压(PaCO₂)均有明显改善(P＜0.05)。治疗后,与对照组比较,观察组患者上述指标均显著改善,差异有统计学意义(P＜0.05)。治疗期间,观察组与对照组患者不良事件发生率[26.0%(13/50)和34.0%(17/50),P=0.383]、依从性差发生率[24.0%(12/50)和34.0%(17/50),P=0.271]比较差异无统计学意义。结论 老年COPD合并呼吸衰竭患者在常规治疗基础上居家应用NPPV可改善症状,提高生活质量,同时减少了住院费用,值得推广。

Abstract:

Objective To investigate the efficacy and compliance of home noninvasive positive pressure ventilation (NPPV) in the elderly patients with chronic obstructive pulmonary disease (COPD) combined with respiratory failure. Methods A total of 100 elderly COPD patients with respiratory failure who were discharged after treatment in our department from January 2016 to December 2017 were recruited in this study. They were randomly divided into observation group and control group, with 50 cases in each group. The patients in the control group were given routine treatment at home, including expectoration, clearance of respiratory tract, anti-spasmodic and anti-asthmatic drugs, anti-infection and long-term oxygen inhalation. While those of the observation group received home NPPV on the basis of all above treatments as the control group. During 1 year′s follow-up, hospitalization, quality of life (SF-36 scale), dyspnea (St. George′s questionnaire), 6-minute walking test (6MWT), pulmonary function, arterial blood gas indices,compliance and incidence of adverse events before and after treatment were recorded and compared between the 2 groups. SPSS statistics 21.0 was used to analyze the data. According to the data types, Student′s t test or Chi-square test was employed for comparison between the two groups. Results During the follow-up of 1 year, the length of hospital stay was a little bit longer [(14.32±3.41) vs (13.33±2.54)d, t=1.646, P>0.05], while the hospital costs were significantly larger [(21.2±2.6) ×10³ vs (15.7±1.5) ×10³ yuan, t=12.956, P<0.05] in the control group than the observation group. The quality of life score, dyspnea score, 6MWT, forced expiratory volume in one second (FEV1), partial pressure of oxygen (PaO₂) and partial pressure of carbon dioxide(PaCO₂) were significantly improved in the both groups after treatment (P<0.05). The observation group had more significantly improved above indicators when compared with the control group (P<0.05). During the treatment period, there were no significant differences in the incidence of adverse events [26.0%(13/50) vs 34.0%(17/50), P=0.383] and the incidence of poor compliance [24.0%(12/50) vs 34.0%(17/50), P=0.271] between the observation group and the control group. Conclusion For the elderly COPD patients with respiratory failure, home NIPPV is worthy of promotion on the basis of routine therapies, because it relieves the symptoms, improves quality of life, and reduces hospital costs.