肥胖对慢性阻塞性肺疾病稳定期病人无创机械通气治疗效果的影响

doi:10.3969/j.issn.1003-9198.2022.01.006

实用老年医学 ›› 2022, Vol. 36 ›› Issue (1): 19-22.doi: 10.3969/j.issn.1003-9198.2022.01.006

肥胖对慢性阻塞性肺疾病稳定期病人无创机械通气治疗效果的影响

胡玉洁, 袁伟锋, 李好华, 伍伟玲

510062 广东省广州市,中国人民解放军南部战区空军医院呼吸与危重症医学科(胡玉洁,伍伟玲);
510440 广东省广州市,广州医科大学附属市八医院呼吸科(袁伟锋);
510010 广东省广州市,中国人民解放军南部战区总医院呼吸与危重症医学科(李好华)

收稿日期:2021-05-08 出版日期:2022-01-20 发布日期:2022-01-25
通讯作者: 伍伟玲,Email:123605590@qq.com
基金资助:
广东省医学科学技术研究基金资助项目(B2020082,B2021027)

Influence of obesity on the effect of non-invasive mechanical ventilation in patients with stable chronic obstructive pulmonary disease

HU Yu-jie, YUAN Wei-feng, LI Hao-hua, WU Wei-ling

HU Yu-jie, WU Wei-ling. Department of Pulmonary and Critical Care Medicine, Air Force Hospital of Southern Theatre Command of PLA, Guangzhou 510062, China;
YUAN Wei-feng. Department of Respiratory Medicine, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou 510440, China;
LI Hao-hua. Department of Pulmonary and Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China

Received:2021-05-08 Online:2022-01-20 Published:2022-01-25

摘要/Abstract

摘要： 目的探讨肥胖对进行无创机械通气的稳定期COPD病人疗效的影响。方法纳入80例满足COPD全球倡议(GOLD)D组标准的病人,根据BMI分为对照组与肥胖组,每组40例。2组病人均按GOLD关于D组COPD的诊疗建议进行药物治疗,无创正压通气治疗每天至少6~8 h。观察时间为3个月。治疗前后分别检测2组病人的动脉血气指标及CRP、呼出气一氧化氮(FeNO)浓度,COPD评估测试(CAT)评分、6 min步行距离(6MWD),记录3个月内急性加重次数等,并进行组间比较。结果与治疗前相比,2组病人治疗后PaO₂显著增高,PaCO₂显著降低(P<0.01),对照组动脉血气结果优于肥胖组(P<0.01),对照组CRP浓度在治疗后显著下降(P<0.01),但肥胖组CRP在治疗前后差异无统计学意义(P>0.05)。治疗后对照组病人FeNO水平低于肥胖组(P<0.01)。肥胖组治疗后CAT评分与6MWD均有改善,但仍以对照组较佳。随访期间,2组病人急性加重次数与住院情况差异无统计学意义。结论无创通气治疗能有效缓解COPD病人的症状,更有效提高肥胖病人的活动耐量,但对于肥胖病人,活动耐量仍低于非肥胖者,与其气道炎症状态高于非肥胖者有关。

关键词: 慢性阻塞性肺疾病, 肥胖, 无创机械通气

Abstract: Objective To investigate the effects of besity on the efficacy of non-invasive ventilation (NIV) in the patients with stable chronic obstructive pulmonary disease (COPD). Methods A total of 80 patients with stable COPD were admitted and divided into control group (BMI<25) and obesity group(BMI>30) according to BMI, with 40 patients in each group. Both groups were given the treatment of drug combined with NIV according to GOLD. The levels of arterial blood gas, C reactive protein(CRP) and fractional exhaled nitric oxide(FeNO), COPD assessment test(CAT) score and 6 minute walking distance (6MWD), times of hospitalization were compared between the two groups. Results After the treatment with NIV, the level of PaO₂ increased, and the level of PaCO₂ decreased significantly in the two groups, especially in control group(P<0.05). After treatment, the level of CRP was significantly decreased in control group, but showing no significant change in obesity group. The level of FeNO was significantly lower in control group than that in obesity group (P<0.05). The score of CAT and 6MWD were significantly improved in obesity group after treatment, but were lower than those in control group (P<0.05). The time of hospitalization showed no significant difference between the two groups. Conclusions The treatment of NIV can relieve the clinical symptoms of COPD combined with obesity. However, the COPD patients presenting with obesity get poorer treatment effect. Invasive ventilation is considered to be an alternative for obesitive COPD patients.

Key words: chronic obstructive pulmonary disease, obesity, non-invasive ventilation

中图分类号:

R 563

胡玉洁, 袁伟锋, 李好华, 伍伟玲. 肥胖对慢性阻塞性肺疾病稳定期病人无创机械通气治疗效果的影响[J]. 实用老年医学, 2022, 36(1): 19-22.

HU Yu-jie, YUAN Wei-feng, LI Hao-hua, WU Wei-ling. Influence of obesity on the effect of non-invasive mechanical ventilation in patients with stable chronic obstructive pulmonary disease[J]. Practical Geriatrics, 2022, 36(1): 19-22.

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肥胖对慢性阻塞性肺疾病稳定期病人无创机械通气治疗效果的影响

Influence of obesity on the effect of non-invasive mechanical ventilation in patients with stable chronic obstructive pulmonary disease

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