葛南海?蔡孝桢?肖长长?吴妙霞

[摘要] 目的 评估夜间无创通气对COPD所致肺动脉高压患者的影响，并寻找改善COPD合并肺动脉高压患者预后的可行方法。 方法 选择2014年12月～2016年12月于我院住院及门诊随诊的42例重度-极重度COPD合并肺动脉高压患者作为研究对象，在征得本院伦理委员会批准及患者知情同意下采用等距随机抽样法分为对照组28例（家庭氧疗）及研究组14例（经面罩双水平正压通气治疗）对两组肺动脉压力、肺通气功能、6分钟步行距离（6MWD）、CAT评分进行比较。 结果 长期夜间无创通气可降低慢阻肺合并肺动脉高压患者肺动脉压力、延缓FEV1下降，治疗后CAT评分研究组低于对照组，6MWD高于对照组，差异有统计学意义（P<0.05）。 结论 对于重度-极重度COPD合并肺动脉高压患者，在长期氧疗及使用吸入糖皮质激素-长效支气管舒张剂基础上，无创通气可缓解FEV1和运动耐力下降，改善或者生活质量。

[关键词] 慢性阻塞性肺疾病；肺动脉高压；无创辅助通气；肺功能；CAT评分

[中图分类号] R544.1 [文献标识码] A [文章编号] 2095-0616（2017）09-248-04

Effect of noninvasive ventilation on quality of life in patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension

GE Nanhai CAI Xiaozhen XIAO Changchang WU Miaoxia

Department of Respiratory Medicine，the Affiliated Houjie Hospital of Guangdong Medical University，Guangzhou 523960，China

[Abstract] Objective To evaluate the effect of noninvasive ventilation on COPD-induced pulmonary hypertension，and to find a feasible method to improve the prognosis of COPD patients with pulmonary hypertension. Methods 42 patients with severe-severe COPD complicated with pulmonary hypertension cured in our hospital from December 2014 to December 2016 were selected as the subjects.Under the approval of the ethics committee and the patients informed consent，the patients were divided into control group （n=28，treated with home oxygen therapy） and study group （n=14，treated with mask bi level positive airway pressure）.The pulmonary arterial pressure，pulmonary ventilation function，6 minutes walking distance （6MWD） and CAT scores of the two groups were compared. Results Long-term noninvasive ventilation at night could reduce the pulmonary artery pressure and delay FEV1 in patients with COPD complicated with pulmonary hypertension.There was a significant difference between the two groups after CAT score and 6-minute walking distance （6MWD） （P<0.05）. Conclusion Noninvasive ventilation relieves FEV1 and decreases exercise tolerance in patients with severe-severe COPD complicated with pulmonary hypertension，with long-term oxygen therapy and inhaled glucocorticoid- long-acting bronchodilator.

[Key words] Chronic obstructive pulmonary disease；Pulmonary hypertension；Noninvasive auxiliary ventilation；Pulmonary function；CAT score

慢性阻塞性肺疾病（慢阻肺）是一種具有气流阻塞特征的肺气肿和（或）慢性支气管炎，可发展为肺心病和呼吸衰竭，全球40岁以上发病率高达9%～10%[1]。慢性阻塞性肺疾病（COPD）由于缺氧引起肺血管收缩、内膜增厚、肌型小动脉形成从而导致肺血管重构[2]。气道结构改变，气道阻力增加；肺动态过度充气、血管内皮功能障碍、酸中毒、真性红细胞增多症、炎症和肺实质破坏均会导致COPD患者肺血管阻力增加导致肺动脉高压（pulmonary hypertension，PH）形成[3]。有实验表明6min步行试验比肺通气功能FEV1更好地预测慢阻肺患者死亡率[4]。COPD评估测试（COPD Assessment Test，CAT）是由患者本人完成的测试问卷，用于对COPD健康状况进行简便而可靠的评价，便于医生和患者更快捷全面地了解病情，指导和监督治疗[5]。……