黄颂平 陈冬冬 蔡志明 沈冰寒 叶晓艺

[關键词] 慢性阻塞性肺疾病;表型;无创正压通气;呼吸衰竭

[中图分类号] R563.9;R563.8          [文献标识码] A          [文章编号] 1673-9701（2021）29-0028-04

Clinical efficacy of non-invasive positive pressure ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease with respiratory failure of different phenotypes

HUANG Songping   CHEN Dongdong   CAI Zhiming   SHEN Binghan   YE Xiaoyi

Department of Respiratory and Critical Care Medicine，Quanzhou First Hospital Affiliated to Fujian Medical University，Quanzhou   362000，China

[Abstract] Objective To investigate the clinical efficacy of non-invasive positive pressure ventilation（NPPV） in the treatment of acute exacerbation of chronic obstructive pulmonary disease（AECOPD） with respiratory failure of different phenotypes. Methods A total of 143 patients with AECOPD complicated with respiratory failure admitted to our hospital from May 2018 to May 2020 were selected and divided into infrequent acute exacerbation group（<2 times/year，n=71） and frequent acute exacerbation group（≥2 times/year，n=72）according to the number of exacerbations in the past year.According to the randomization method，the infrequent acute exacerbation group consisted of 36 cases of infrequent exacerbation in the control group（conventional treatment） and 35 cases of infrequent exacerbation in the observation group（conventional treatment + NPPV）.The frequent exacerbation group consisted of 36 cases of frequent exacerbation（conventional treatment）in the control group and 36 cases of frequent exacerbation（conventional treatment+NPPV）in the observation group.The changes in blood gas parameters and the therapeutic effect of NPPV，and the composition of complications were observed. Results There was no significant difference in blood gas indexes of the infrequent exacerbation between the observation and control groups at 24 h，3 d，and 7 d after treatment（P>0.05）. There were significant differences in pH value，PaCO2，and PaO2 of the frequent exacerbation between the observation and control groups at 24 h，3 d，and 7 d after NPPV treatment （P<0.05）. For AECOPD patients with respiratory failure treated with NPPV，there were significant differences in pH，PaCO2 and PaO2 at 24 hours，3 days and 7 days between frequent acute exacerbation group and non-frequent acute exacerbation group （P<0.05）.The combination of sleep apnea-hypopnea syndrome （SAHS） in the frequent acute exacerbation group was significantly increased compared with that in the infrequent acute exacerbation group（26.39% vs. 11.27%），and the difference had statistical significance（P<0.05）. Conclusion For patients with AECOPD and respiratory failure with frequent acute exacerbation phenotype，especially those with SAHS，non-invasive positive pressure ventilation is recommended as early as possible in order to obtain better clinical results.

[Key words] Chronic obstructive pulmonary disease; Phenotype; Non-invasive positive pressure ventilation; Respiratory failure

慢性阻塞性肺疾病急性加重（AECOPD）是导致患者反复住院、日常生活质量下降、病死率增加的主要危险因素，给社会和家庭带来沉重疾病负担。对慢阻肺表型的研究越来越受到关注，尤其是“频繁急性加重型慢性阻塞性肺疾病”（Frequentexacerbator phenotype）已被独立地列为慢性阻塞性肺疾病的一种重要的临床表型，须根据风险分层和临床表型进行个体化治疗[1]。研究证实，AECOPD合并呼吸衰竭使用无创正压通气（NPPV）可以提高生存率，降低气管插管的比率、重症监护病房（ICU）的住院成本和死亡率，已成为首选呼吸支持方式[2]。但是临床实践中NPPV的应用效果受到很多因素影响，包括团队应用的经验等。本研究拟探讨无创正压通气治疗不同表型AECOPD合并呼吸衰竭的临床疗效，现报道如下。

1 资料与方法

1.1 一般资料

选择我院2018年5月至2020年5月收治的AECOPD患者143例，年龄52～80岁，符合纳入标准：①参照《慢性阻塞性肺疾病诊治指南》[3]诊断为AECOPD的患者;②符合呼吸衰竭标准[4]：呼吸空气的静息状态下，PaCO2>50 mmHg伴或不伴PaO2<60 mmHg;③符合NPPV应用指征：中、重度呼吸困难，胸腹矛盾运动;pH值7.25～7.35之间和PaCO2 45～80 mmHg之间。入院时住院医师询问病史，根据慢性阻塞性肺疾病急性加重表型诊断标准[5]，且动脉血气分析pH<7.35，PaCO2>50 mmHg的患者，过去1年急性加重发作次数分为非频繁急性加重组71例（<2次/年）和频繁急性加重组72例（≥2次/年）。按照随机分组法，非频繁急性加重组……