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目的:探讨噻托溴铵和无创机械通气联合应用在重度稳定期慢性阻塞性肺疾病(COPD)患者治疗中的价值。方法:采取平行、对照、随机研究。将40例病人随机分为噻托溴铵组(T)和噻托溴铵加无创机械通气组(T+B),研究周期为8周。在治疗前1d,第4周末,第8周末分别血气分析、肺功能,并通过Borg评分、6min步行试验(6MWT)、圣乔治呼吸问卷(SGRQ)对患者总体健康状况进行评价。结果:治疗前后比较,T组IC明显增高(P<0.05),FEV1、FEV1占预计值百分比、FEV1/FVC无明显增高;而T+B组FEV1、FEV1占预计值百分比、FEV1/FVC和IC均增高(P<0.05);两组间比较,T+B组FEV1、FEV1占预计值百分比、FEV1/FVC均高于T组(P<0.05);T组、T+B组PaO2均明显增高(P<0.05),而PaCO2均无明显变化;两组间PaO2和PaCO2无显著性差异;T组、T+B组6MWD均明显提高,而Borg评分均明显下降(P<0.05),两组间6MWD和Borg评分无显著性差异。两组SGRQ下降均超过4分,T+B组SGRQ明显低于T组(P<0.05)。结论:两组病人中,氧分压得到了明显地改善,运动的耐受力、呼吸困难指数和生活质量都得到了明显的提高,表明噻托溴铵在重度稳定期COPD患者康复治疗中具有重要的价值;与单一噻托溴铵治疗组比较,联合治疗组FEV1得到了明显的改善,SGRQ评分明显下降,表明后者优于前者。
Objective: To investigate the value of tiotropium in combination with non-invasive mechanical ventilation in the treatment of patients with severe chronic obstructive pulmonary disease (COPD). Methods: A parallel, controlled, randomized study. Forty patients were randomized to tiotropium (T) and tiotropium plus noninvasive mechanical ventilation (T + B) for a study period of 8 weeks. Blood gas analysis and pulmonary function were performed on the first day, the fourth week and the eighth week before treatment, respectively. The patients’ overall health status was assessed by Borg score, 6-minute walk test (6MWT) and St. George’s Respiratory Questionnaire (SGRQ). Results: Before and after treatment, the IC of T group was significantly higher (P <0.05), FEV1 and FEV1 accounted for the percentage of predicted value, while FEV1 / FVC was not increased obviously; while FEV1 and FEV1 of T + (P <0.05). The FEV1 and FEV1 values of FEV1 and FEV1 in T + B group were significantly higher than those in T group (P <0.05), PaO2 in T group and T + B group were significantly increased (P <0.05), PaCO2 had no significant difference between the two groups PaO2 and PaCO2 no significant difference; T group, T + B group 6MWD were significantly increased, while the Borg score were significantly decreased (P <0.05) There was no significant difference between 6MWD and Borg scores. SGRQ decreased more than 4 points in both groups, SGRQ in T + B group was significantly lower than that in T group (P <0.05). CONCLUSIONS: Oxygen partial pressure was significantly improved in both groups, and exercise tolerance, dyspnea index, and quality of life were significantly improved, indicating that tiotropium has a significant effect on rehabilitation of patients with severe stable COPD Important value; Compared with the single Tiotropium treatment group, the combination therapy group FEV1 has been significantly improved, SGRQ score decreased significantly, indicating that the latter is better than the former.