Study Of Rehabilitation Effect Of Nocturnal Noninvasive Positive Pressure Ventilation On Patients With Stable COPD

Objective:To study the rehabilitation effects of nocturnal noninvasive positive pressure ventilation(NIPPV)in treatment of stable patients with chronic obstructive pulmonary disease(COPD).Methods:We conducted a randomized,controlled trial.Thirty stable patients with severe COPD(GOLD stagesâ…¢andâ…£)were randomly devided into experimental group and control group.Nocturnal BiPPV plus oxygen therapy was applied in the experimental group for 8 weeks,while simple oxygen therapy in the control group.Such items as polysomnography,blood gas analysis,lung function,six minutes walk distance(6MWD),St George's Respiratory Questionnaire(SGRQ)and dyspnea index were performed in all patients before the trial,after 4 weeks and 8 weeks.The rehabilitation effects of NIPPV in treatment of stable patients with severe COPD were evaluated by comparative analysis.Results:27 patients finished the study,including 14 cases in the experimental group and 13 cases in the control group.â‘ The incidence of overlap syndrome was 22.2%in these COPD patients.Stagesâ… andâ…¡were the main sleep stages.There were frequent micro-arousal and severe hypoxemia during their sleep.For the experimental group,sleep efficiency and sleep structure were improved after treatment.Micro-arousal index(MAI)and apnea-hypopnea index(AHI)decreased obviously.The noctumal lowest oxygen saturation (LS_aO₂)was improved significantly.Time ratio of oxygen saturation below 90% to the total sleep time(TS90%)decreased significantly.For the control group, sleep efficiency and LS_aO₂ were also significantly improved.TS90%decreased significantly.But AHI increased obviously.Sleep structure and MAI did not changed significantly.â‘¡For the experimental group,morning P_aO₂ was significantly improved and P_aCO₂ significantly decreased after treatment.For the control group,P_aO₂ was significantly improved,too.After 8 weeks,P_aO₂ in the experimental group was higher than that in the control group,and P_aCO₂ in the experimental group was lower.â‘¢For the experimental group,FEV₁ significantly increased after 8 weeks.Tidal volume,FVC and FEV₁%did not changed obviously before and after treatment in both groups.â‘£6MWD in the experimental group was longer than the control group after both 4 weeks and 8 weeks.⑤Dyspnea in the experimental group was improved better than the control.â‘¥For the experimental group,the improvement of SGRQ total score was-7.83 at week 4 and -9.74 at week 8.Health-related life quality of the experimental group was better than the control.Conclusions:For stable patients with severe COPD(GOLD stagesâ…¢andâ…£), nocturnal NIPPV can significantly improve their sleep quality,hypoxemia, dyspnea,exercise endurance and life quality.The rehabilitation effects of NIPPV was better than simple nocturnal oxygen therapy.Therefore,NIPPV may be a very useful method of lung rehabilitation.