英国慢性阻塞性肺疾病（COPD）急性加重期患者的无创通气（NIPPV）调查。
Survey of non-invasive ventilation (NIPPV) in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) in the UK.
作者信息
Doherty M J, Greenstone M A
机构信息
Medical Chest Unit, Castle Hill Hospital, Cottingham, East Yorkshire, UK.
出版信息
Thorax. 1998 Oct;53(10):863-6. doi: 10.1136/thx.53.10.863.
BACKGROUND
Non-invasive positive pressure ventilation (NIPPV) has been shown to be beneficial in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD) complicated by respiratory failure. A survey was undertaken to assess the availability of NIPPV for the treatment of acute exacerbations of COPD and to determine how NIPPV is delivered in hospitals in the UK.
METHODS
A questionnaire was sent to consultants with an interest in respiratory medicine from 268 of the hospitals found in the BTS directory. The questionnaire enquired about the hospital as well as the availability of NIPPV in the hospital. If NIPPV was available in the hospital, details of implementation, staffing and funding were determined.
RESULTS
Replies to the questionnaire were received from 98.5% of consultants. NIPPV was available in 48% of hospitals, these hospitals tending to serve larger populations and to have more respiratory physicians than the hospitals where NIPPV was not available. There was considerable regional variation in the availability of NIPPV. In hospitals where NIPPV was not available the reason(s) were lack of consultant training in 53%, lack of other staff training in 63%, financial in 63%, and doubt about the benefit of NIPPV in 15% of cases. In those hospitals where NIPPV was available, clinical practice varied greatly: 68% of centres treated fewer than 20 patients a year with this form of treatment and 9% treated more than 60 patients a year. Although NIPPV was paid for completely from the trust equipment budget in 46 hospitals (41%), other money such as research or charitable funds were used at least partially in the other hospitals and NIPPV was financed solely from research or charitable funds in 41 hospitals (37%).
CONCLUSIONS
Equipment for NIPPV is available in less than half of the acute hospitals in the UK. In those in which it is available it is generally underused. Lack of training and problems with funding are generally given for the failure to introduce NIPPV.
背景
无创正压通气（NIPPV）已被证明对治疗合并呼吸衰竭的慢性阻塞性肺疾病（COPD）急性加重有益。开展了一项调查，以评估NIPPV用于治疗COPD急性加重的可及性，并确定英国医院中NIPPV是如何提供的。
方法
向英国胸科学会（BTS）名录中268家医院的呼吸内科顾问发送了问卷。问卷询问了医院以及医院中NIPPV的可及性。如果医院有NIPPV，还确定了实施、人员配备和资金方面的细节。
结果
98.5%的顾问回复了问卷。48%的医院有NIPPV，与没有NIPPV的医院相比，这些医院往往服务于更多人口且有更多呼吸内科医生。NIPPV的可及性存在显著的地区差异。在没有NIPPV的医院中，53%的原因是缺乏顾问培训，63%是缺乏其他工作人员培训，63%是资金问题，15%是对NIPPV益处的怀疑。在有NIPPV的医院中，临床实践差异很大：68%的中心每年用这种治疗方式治疗的患者少于20例，9%的中心每年治疗的患者超过60例。虽然46家医院（41%）的NIPPV完全由信托设备预算支付，但其他医院至少部分使用了研究或慈善基金等其他资金，41家医院（37%）的NIPPV完全由研究或慈善基金资助。
结论
英国不到一半的急症医院有NIPPV设备。在有该设备的医院中，其通常未得到充分利用。缺乏培训和资金问题通常被认为是未能引入NIPPV的原因。
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