Blankenburg Th, Roloff D, Schädlich S, Crieé C P, Schütte W
Klinik für Innere Medizin II, Zentrum für Heimbeatmung und Respiratorentwöhnung, Krankenhaus Martha-Maria Halle-Dölau.
Pneumologie. 2008 Mar;62(3):126-31. doi: 10.1055/s-2007-993036. Epub 2008 Jan 16.
In patients with severe COPD, ventilatory pump failure is a separate pathophysiological factor. Non-invasive ventilatory support has been introduced in COPD with acute-on-chronic respiratory failure according to evidence-based medicine, but the benefit of long-term ventilation is still not proven. The purpose of this investigation was to evaluate the feasibility of carbon dioxide-reducing, non-invasive, home mechanical ventilation in patients with chronic hypercapnic respiratory failure due to stable COPD.
In 40 patients (median age 72.2/61.1 - 78.1 years), with chronic ventilatory failure due to COPD who received non-invasive, home mechanical ventilation (NIV) successfully we analysed blood gases, lung function, 6-minute walking distance and quality of life before NPPV and after a period of at least 4 weeks of home therapy.
Successful home mechanical ventilation could be proven by a significant decrease of hypercapnia during spontaneous breathing: 8.5 kPa (64.6 mmHg) before NIV to 5.9 kPa (45.2 mm Hg) during NIV. Six-minute walking distance increased significantly from 89 m to 230 m. General health perception (SF 36) improved from 27 to 56 significantly as did other quality of life categories.
Although this investigation has some limitations such as lack of controls and highly selected patients, it could be proven that CO (2)-decreasing, non-invasive mechanical ventilation is feasible in terms of home therapy and effective to recompensate chronic ventilatory failure in stable COPD. Under such treatment, patients can reestablish their physical ability and report quality of life improvements.
在重度慢性阻塞性肺疾病（COPD）患者中，通气泵衰竭是一个独立的病理生理因素。根据循证医学，无创通气支持已被应用于慢性阻塞性肺疾病急性加重合并慢性呼吸衰竭的患者，但长期通气的益处仍未得到证实。本研究的目的是评估在稳定期COPD导致的慢性高碳酸血症呼吸衰竭患者中，进行降低二氧化碳的无创家庭机械通气的可行性。
对40例（年龄中位数72.2/61.1 - 78.1岁）因COPD导致慢性通气衰竭且成功接受无创家庭机械通气（NIV）的患者，我们分析了在进行无创正压通气（NPPV）前以及经过至少4周家庭治疗后的血气、肺功能、6分钟步行距离和生活质量。
成功的家庭机械通气可通过自主呼吸时高碳酸血症的显著降低得到证实：无创通气前为8.5 kPa（64.6 mmHg），无创通气期间为5.9 kPa（45.2 mmHg）。6分钟步行距离从89米显著增加至230米。总体健康感知（SF - 36）从27显著提高至56，其他生活质量类别也有改善。
尽管本研究存在一些局限性，如缺乏对照和患者选择具有高度选择性，但可以证明，降低二氧化碳的无创机械通气在家庭治疗方面是可行的，并且对于稳定期COPD患者慢性通气衰竭的代偿是有效的。在这种治疗下，患者能够恢复身体能力并报告生活质量有所改善。
