Efficacy of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension

doi:10.3877/cma.j.issn.1674-6902.2017.03.008

Abstract

Abstract:

Objective

To investigate the therapeutic effect of noninvasive positive pressure ventilation on chronic obstructive pulmonary disease (COPD) complicated with pulmonary hypertension (PH).

Method

Patients admitted to hospital from October 2014 to January 2016 were treated with stable COPD and pulmonary hypertension, and sPAP was measured by echocardiography in all patients (>40 mmHg). 136 patients, including 121 males and 15 females, with an average age of (60.3±11.3)years, were randomly divided into noninvasive positive pressure ventilation (NPPV) group and conventional treatment group. The FEV₁/predictive value, oxygenation index, PCO₂, sPAP, BNP were compared between the two groups before and after treatment, and the correlation between sPAP and the oxygenation index, PCO₂, BNP and FEV₁/predictive value were analyzed.

Result

①There was significantly improved between the NPPV group after treatment and NPPV group before treatment and the conventional group after treatment in the oxygenation index, PCO₂, BNP (P<0.05), but FEV₁/predicted value, sPAP no statistical difference (P>0.05). There was no significant difference between the two groups before and after treatment in conventional group (P>0.05); ②According to the values of sPAP were divided into A group (40 mmHg<sPAP≤60 mmHg) and B group (sPAP>60 mmHg). Stratified study showed that the FEV₁/predictive value, BNP, sPAP were not significantly different before and after treatment between the group A and group B in the conventional group (P>0.05). The oxygenation index, PCO₂, BNP, sPAP in NPPV after treatment of group A were improved between the NPPV before treatment and the conventional after treatment in group A (P<0.05); the oxygenation index, PCO₂, BNP in B group after treatment were significantly improved than before treatment and the conventional after treatment in group B (P<0.05), but FEV₁/predicted value, sPAP no statistical difference (P>0.05); ③sPAP was negatively correlated with oxygenation index and positively correlated with BNP (P<0.05).

Conclusion

Noninvasive positive pressure ventilation is safe and effective in the treatment of elderly patients with chronic obstructive pulmonary disease and mild pulmonary hypertension.

Key words: Noninvasive positive pressure ventilation, Chronic obstructive pulmonary disease, Pulmonary hypertension, sPAP

Yibo Shen, Hongyu Nie, Kai Sun, Donglan Xu, Liang Xiao, Juan Miu, Mingdong Hu. Efficacy of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2017, 10(03): 281-285.

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Figures/Tables 3

References 18

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临床资料	常规组		NPPV治疗组
临床资料	治疗前	治疗后	治疗前	治疗后
年龄(岁)	64(52～75)	?	63(55～76)	?
性别(男/女)	52/8	?	60/6	?
BMI(kg/m²)	23.2±3.2	22.5±2.0	22.9±2.9	22.8±3.7
FEV₁/预计值(%)	57.8±9.7	55.4±8.7	56.7±8.7	58.8±5.1
氧合指数	259.7±31.9	261.0±29.9	249.1±32.1	322.8±20.2^ab
PCO₂(mmHg)	64.7±8.7	62.5±7.9	66.2±7.8	51.3±4.5^ab
BNP(pg/ml)	275.9±40.2	297.8±32.8	285.4±43.2	127.5±21.2^ab
sPAP(mmHg)	59.2±9.3	58.3±10.4	58.5±8.4	49.4±7.7

临床资料	常规组		NPPV治疗组
临床资料	治疗前	治疗后	治疗前	治疗后
年龄(岁)	64(52～75)	?	63(55～76)	?
性别(男/女)	52/8	?	60/6	?
BMI(kg/m²)	23.2±3.2	22.5±2.0	22.9±2.9	22.8±3.7
FEV₁/预计值(%)	57.8±9.7	55.4±8.7	56.7±8.7	58.8±5.1
氧合指数	259.7±31.9	261.0±29.9	249.1±32.1	322.8±20.2^ab
PCO₂(mmHg)	64.7±8.7	62.5±7.9	66.2±7.8	51.3±4.5^ab
BNP(pg/ml)	275.9±40.2	297.8±32.8	285.4±43.2	127.5±21.2^ab
sPAP(mmHg)	59.2±9.3	58.3±10.4	58.5±8.4	49.4±7.7

组　别	分　组	FEV₁/预计值	氧合指数	PCO₂	BNP	sPAP
常规组	A组治疗前	61.8±6.1	279.7±31.9	62.7±6.7	235.9±40.2	54.2±7.3
?	A组治疗后	56.8±6.7	270.7±31.9	59.7±6.1	275.9±40.2	55.2±6.3
?	B组治疗前	49.4±7.7	230.0±18.9	68.5±7.9	327.8±42.8	65.3±6.1
?	B组治疗后	50.2±6.9	248.1±16.1	65.5±6.0	352.9±31.7	64.9±6.9
NIPPV组	A组治疗前	60.7±5.4	269.7±30.3	63.1±4.1	245.4±33.2	55.5±6.4
?	A组治疗后	62.7±4.0	345.1±21.4^ab	48.5±4.7^ab	109.7±32.7^ab	44.3±4.1^ab
?	B组治疗前	48.4±5.7	232.8±31.0	68.3±7.5	356.5±40.9	65.9±6.0
?	B组治疗后	50.9±5.9	305.1±15.9^cd	54.2±3.0^cd	179.6±44.7^cd	59.2±4.2

组　别	分　组	FEV₁/预计值	氧合指数	PCO₂	BNP	sPAP
常规组	A组治疗前	61.8±6.1	279.7±31.9	62.7±6.7	235.9±40.2	54.2±7.3
?	A组治疗后	56.8±6.7	270.7±31.9	59.7±6.1	275.9±40.2	55.2±6.3
?	B组治疗前	49.4±7.7	230.0±18.9	68.5±7.9	327.8±42.8	65.3±6.1
?	B组治疗后	50.2±6.9	248.1±16.1	65.5±6.0	352.9±31.7	64.9±6.9
NIPPV组	A组治疗前	60.7±5.4	269.7±30.3	63.1±4.1	245.4±33.2	55.5±6.4
?	A组治疗后	62.7±4.0	345.1±21.4^ab	48.5±4.7^ab	109.7±32.7^ab	44.3±4.1^ab
?	B组治疗前	48.4±5.7	232.8±31.0	68.3±7.5	356.5±40.9	65.9±6.0
?	B组治疗后	50.9±5.9	305.1±15.9^cd	54.2±3.0^cd	179.6±44.7^cd	59.2±4.2

?	?	FEV₁/预计值	氧合指数	PCO₂	BNP
sPAP	r值	－0.289	－0.519	0.202	0.530
?	P值	>0.05	<0.05	>0.05	<0.05

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