中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

无创正压通气辅助踏车运动在稳定期重度慢性阻塞性肺疾病患者的实施与疗效观察

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目的 探讨无创正压通气(NIPPV)辅助踏车运动对稳定期重度慢性阻塞性肺疾病(简称慢阻肺)患者呼吸困难及运动耐力等的影响。 方法 研究选取 2015 年 8 月至 2016 年 1 月于我院呼吸与危重症医学科肺康复单元住院的 20 例稳定期重度慢阻肺患者。患者进行 8 周的 NIPPV 辅助踏车运动,通过自身对照方法,测定治疗前及治疗 8 周后 12 分钟步行距离、Borg 呼吸困难指数、平均肺动脉压(mPAP)、日间动脉血氧分压(PaO 2)及二氧化碳分压(PaCO 2)值,治疗前后 1 年内慢阻肺急性加重次数,并观察治疗过程中的不良反应及依从性。 结果 治疗后 12 分钟步行距离 [(810±20)m 比(680±15)m]、Borg 呼吸困难指数 [(2.4±0.1)分比(4.4±0.3)分]、mPAP [(34.4±2.7)mm Hg 比(43.5±3.8)mm Hg]、PaCO 2 [(49.8±4.9)mm Hg 比(64.3±5.2)mm Hg]、PaO 2 [(64.4±4.1)mm Hg 比(52.3±3.9)mm Hg] 均较治疗前显著改善,治疗后 1 年内慢阻肺急性加重次数也较治疗前显著减少 [(2.1±0.7)次比(4.3±2.1)次] ,差异均有统计学意义(P<0.01)。治疗不良反应为口咽干燥 2 例、胃胀气 8 例,均可以耐受。 结论 NIPPV 辅助踏车运动可提高稳定期重度慢阻肺患者的运动耐力,改善呼吸困难,提高氧合并降低 mPAP,减少 1 年内慢阻肺急性加重次数。

Objective To investigate the effects of mask BiPAP noninvasive positive ventilation (NIPPV) during treadmill exercise on dyspnea index and exercise endurance in stable patients with severe chronic obstructive pulmonary disease (COPD). Methods Twenty inpatients with stable severe COPD between August 2015 and January 2016 were recruited in the study. The following parameters were measured before and after 8-week rehabilitation by NIPPV during treadmill exercises, including 12-minute walking distance (12MWD), Borg dyspnea score, mean pulmonary arterial pressure (mPAP), PaO 2 and PaCO 2, times of acute exacerbation in 1 year, adverse reactions, and adherence. Results After rehabilitation for 8 weeks, the following parameters were improved than those before treatment including 12MWD [(810±20) mvs. (680±15) m,P<0.01], Borg dyspnea score (2.4±0.1vs. 4.4±0.3,P<0.01), mPAP [(34.4±2.7) mm Hgvs. (43.5±3.8) mm Hg], PaCO 2 [(49.8±4.9) mm Hgvs. (64.3±5.2) mm Hg], PaO 2 [(64.4±4.1) mm Hgvs. (52.3±3.9) mm Hg] and the times of acute exacerbation (2.1±0.7vs. 4.3±2.1,P<0.01). Adverse reactions included oropharyngeal drying (2 cases) and gaseous distention (8 cases) which can be tolerated without special treatment. Conclusion Mask NIPPV during treadmill exercise is safe and effective for stable patients with severe COPD and worthy of clinical application.

关键词: 慢性阻塞性肺疾病; 肺康复; 无创正压通气; 踏车运动

Key words: Chronic obstructive pulmonary disease; Pulmonary rehabilitation; Noninvasive positive pressure ventilation; Treadmill exercise

引用本文: 尹辉明, 禹斌, 代友华, 周牡丹. 无创正压通气辅助踏车运动在稳定期重度慢性阻塞性肺疾病患者的实施与疗效观察. 中国呼吸与危重监护杂志, 2017, 16(5): 432-435. doi: 10.7507/1671-6205.201702020 复制

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