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目的:观察无创正压通气联合噻托溴铵治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床效果。方法:2007年12月～2010年12月,112例COPD合并Ⅱ型呼吸衰竭患者随机分为两组,观察组56例采用无创正压通气联合噻托溴铵治疗,对照组56例采用异丙托溴铵气雾剂治疗,比较观察两组的呼吸困难、肺功能以及运动耐力变化。结果:与治疗前比较,观察组治疗后4周、12周呼吸困难评分明显下降(P<0.05),而对照组仅治疗后12周呼吸困难评分明显下降(P<0.05)。观察组治疗后4周、12周呼吸困难评分均明显低于同期对照组水平(P<0.05)。观察组治疗后FEV1、FVC和FEV1/FVC均较治疗前明显升高(P<0.05),而对照组无明显变化(P>0.05);观察组治疗后FEV1、FVC和FEV1/FVC均明显高于同期对照组水平(P<0.05)。两组治疗后6min步行距离均明显长于治疗前(P<0.05);观察组治疗后6min步行距离明显长于同期对照组(P<0.05)。结论:无创正压通气联合噻托溴铵治疗COPD合并Ⅱ型呼吸衰竭,能够明显改善患者的临床症状,改善肺功能状态,提高运动耐力,值得在临床推广应用。
Objective: To observe the clinical effect of noninvasive positive pressure ventilation combined with tiotropium in the treatment of chronic obstructive pulmonary disease (COPD) complicated with type Ⅱ respiratory failure. Methods: From December 2007 to December 2010, 112 patients with COPD and type Ⅱ respiratory failure were randomly divided into two groups. Fifty-six patients in the observation group were treated with noninvasive positive pressure ventilation and tiotropium bromide, and 56 patients in the control group were treated with isopropyl Topaz bromide aerosol treatment, the comparison of two groups of dyspnea, pulmonary function and exercise tolerance changes. Results: Compared with those before treatment, the scores of dyspnea in observation group decreased significantly at 4 weeks and 12 weeks (P <0.05), while those in control group decreased only 12 weeks after treatment (P <0.05). The scores of dyspnea in observation group at 4 weeks and 12 weeks after treatment were significantly lower than those in control group at the same period (P <0.05). The FEV1, FVC and FEV1 / FVC in the observation group were significantly higher than those before treatment (P <0.05), but there was no significant difference in the control group (P> 0.05). The FEV1, FVC and FEV1 / FVC in the observation group were significantly higher In the same period the control group level (P <0.05). The walking distances at 6min after treatment in both groups were significantly longer than those before treatment (P <0.05). The walking distance at 6min after treatment in the observation group was significantly longer than that in the control group at the same period (P <0.05). Conclusion: Noninvasive positive pressure ventilation combined with tiotropium in the treatment of COPD with type Ⅱ respiratory failure can significantly improve the clinical symptoms, improve pulmonary function and improve exercise endurance, which is worthy of clinical application.