无创通气对无呼吸衰竭COPD患者呼吸肌疲劳的影响

目的:观察无创通气(NIPPV)对无呼吸衰竭的轻中度慢性阻塞性肺疾病(COPD)急性加重期患者呼吸肌疲劳的影响。方法:44例COPD患者随机分为NIPPV组和对照组,观察治疗前后两组临床表现、动脉血气、肺功能、辅助呼吸肌动用评分、呼吸困难评分和预后的变化。结果:NIPPV组在通气2h后显著改善动脉血气,降低心率和呼吸频率,减少辅助呼吸肌参与(P<0.05),且在24h后仍与对照组有显著差异。NIPPV组的肺功能在治疗后显著改善,住院时间也明显缩短。结论:轻中度COPD急性加重期患者虽无呼吸衰竭、但已存在呼吸肌疲劳,早期应用NIPPV能迅速缓解呼吸肌疲劳,改善气体交换,缩短住院时间,降低呼吸衰竭的发生率。

Effects of noninvasive positive pressure ventilation on respiratory muscle fatigue in the patients with chronic obstructive pulmonary disease without respiratory failure

Objective: To investigate the effects of noninvasive positive pressure ventilation (NIPPV) on respiratory muscle fatigue in patients with milder chronic obstructive pulmonary disease (COPD) without respiratory failure. Methods: Forty-four patients were randomized to NIPPV group and control group. The clinical manifestations, arterial blood gases, pulmonary functions, dyspnea score, scale for accessory muscle use and outcome were analyzed. Results: Arterial blood gases, respiratory rate, heart rate and scale for accessory muscle use were improved rapidly at the first 2 h in patients of NIPPV group(P < 0.05). The differences between the two groups were kept to 24-h treatment. The pulmonary functions were improved after ventilation,and the duration of hospital was decreased by NIPPV. Conclusion: Although respiratory failure does not occur in patients with milder COPD exacerbations,respiratory muscle fatigue already exists. NIPPV causes a more rapid improvement in respiratory muscle fatigue, gas exchange and decreases the duration of hospital to avoid respiratory failure.