Lu Peng, Wu Xiao-mei, Li Zhao-guo, Yang Cheng-cheng
Department of Respiratory Medicine, Second Affiliated Hospital, Harbin Medical University, Harbin 150086, China.
Zhonghua Yi Xue Za Zhi. 2012 Feb 14;92(6):401-4.
To evaluate the efficacy and safety of home noninvasive positive pressure ventilation (HNIPPV) in hypercapnic patients with stable severe chronic obstructive pulmonary disease (COPD).
Forty four patients (30 males and 14 females, mean age 68.5 years (range: 60 - 80)) were recruited from a total of 106 patients with arterial PaCO2 ≥ 55 mm Hg in Second Hospital Affiliated to Harbin Medical University from January 2009 to December 2010. Their clinical data were collected and analyzed. The patients in the HNIPPV group (n = 20) accepted tiotropium bromide, doxofylline tablets and HNIPPV treatment while those in the control group (n = 24) tiotropium bromide, doxofylline tablets and a low-flow inhalation of oxygen. The entire observation period was 6 months. The parameters before and after 6-month follow-up were compared, including lung function test, 6-min walking distance (6MWD), arterial blood gases (PaO2 and PaCO2), dyspnea grade, scores of emotional disorders and mean pulmonary artery pressure (mPAP).
No significant difference existed in the baseline data between the HNIPPV and control groups. The forced expiratory volume in one second (FEV(1)), forced vital capacity (FVC), inspiratory capacity (IC), 6MWD, PaO2, PaCO2, dyspnea grade, hospitalization rate, anxiety scores, depression scores and mPAP showed no significant difference between the HNIPPV and control groups before treatment. However, at Month 6, the differences of IC, 6MWD, PaO2, PaCO2, dyspnea grade, anxiety scores, depression scores and mPAP in HNIPPV group ((1.80 ± 0.14) L, (266 ± 24) m, (62.6 ± 4.6) mm Hg, (46.8 ± 2.2) mm Hg, (2.2 ± 0.5), (6.5 ± 2.4), (6.0 ± 1.6), (33.8 ± 2.4) mm Hg) were statistically significant compared with the control group ((1.62 ± 0.14) L, (194 ± 23) m, (56.2 ± 3.8) mm Hg, (55.6 ± 3.0) mm Hg, (3.2 ± 0.6), (10.6 ± 2.8), (10.2 ± 2.4), (36.6 ± 2.4) mm Hg) (P values: 0.031, 0.018, 0.025, 0.026, 0.001, 0.013, 0.002, 0.014 respectively). FEV(1) and FVC in the HNIPPV group improved slightly but with no statistically significant difference (all P > 0.05). Two patients in the control group were taken to hospital because of acute exacerbation. And hospitalization rates increased in the control group. But no statistically significant difference existed between the HNIPPV and control groups (P > 0.05). The tolerance and compliance of HNIPPV in the HNIPPV group were better and the patients in the HNIPPV group had no pulmonary barotraumas.
HNIPPV plus tiotropium bromide and doxofylline tablets is both effective and safe in the treatment of hypercapnic patient with stable severe COPD.
评估家庭无创正压通气（HNIPPV）对稳定期重度慢性阻塞性肺疾病（COPD）伴高碳酸血症患者的疗效及安全性。
选取2009年1月至2010年12月哈尔滨医科大学附属第二医院106例动脉血二氧化碳分压（PaCO2）≥55 mmHg的患者，其中44例（男30例，女14例，平均年龄68.5岁，范围60 - 80岁）纳入研究。收集并分析其临床资料。HNIPPV组（n = 20）患者接受噻托溴铵、多索茶碱片及HNIPPV治疗，对照组（n = 24）患者接受噻托溴铵、多索茶碱片及低流量吸氧治疗。整个观察期为6个月。比较6个月随访前后的参数，包括肺功能测试、6分钟步行距离（6MWD）、动脉血气（PaO2和PaCO2）、呼吸困难分级、情绪障碍评分及平均肺动脉压（mPAP）。
HNIPPV组与对照组的基线数据无显著差异。治疗前，两组的一秒用力呼气容积（FEV(1)）、用力肺活量（FVC）、吸气容积（IC）、6MWD、PaO2、PaCO2、呼吸困难分级、住院率、焦虑评分、抑郁评分及mPAP均无显著差异。然而，在第6个月时，HNIPPV组的IC、6MWD、PaO2、PaCO2、呼吸困难分级、焦虑评分、抑郁评分及mPAP（分别为(1.80 ± 0.14) L、(266 ± 24) m、(62.6 ± 4.6) mmHg、(46.8 ± 2.2) mmHg、(2.2 ± 0.5)、(6.5 ± 2.4)、(6.0 ± 1.6)、(33.8 ± 2.4) mmHg）与对照组（分别为(1.62 ± 0.14) L、(194 ± 23) m、(56.2 ± 3.8) mmHg、(55.6 ± 3.0) mmHg、(3.2 ± 0.6)、(10.6 ± 2.8)、(10.2 ± 2.4)、(36.6 ± 2.4) mmHg）相比，差异有统计学意义（P值分别为0.031、0.018、0.025、0.026、0.001、0.013、0.002、0.014）。HNIPPV组的FEV(1)和FVC略有改善，但差异无统计学意义（均P > 0.05）。对照组有2例患者因急性加重住院，对照组住院率增加。但HNIPPV组与对照组之间差异无统计学意义（P > 0.05）。HNIPPV组对HNIPPV的耐受性和依从性较好，且该组患者无肺气压伤发生。
HNIPPV联合噻托溴铵及多索茶碱片治疗稳定期重度COPD伴高碳酸血症患者有效且安全。
