Cumhuriyet University, Sivas, Turkey.
Curr Med Res Opin. 2010 Sep;26(9):2229-36. doi: 10.1185/03007995.2010.508703.
Chronic respiratory failure (CRF) is a syndrome defined by certain disturbances in arterial blood gases. Non-invasive mechanical ventilation (NIMV) is an increasingly used treatment modality in respiratory failure. The aim of this study was to investigate the long-term effects of NIMV on pulmonary function and survival of patients with CRF.
The study enrolled 170 CRF patients who it was decided should receive long-term home mechanical ventilation. Patients were stratified into two distinct groups - Group I (patients for whom NIMV was recommended and who had used it) and Group II (patients for whom NIMV was recommended at least 1 year ago but who had not used it for various reasons). Best arterial blood gas and pulmonary function test values in the year before the NIMV recommendation were obtained from patient records. The same tests were performed at least 1 year (1-5 years) after initiation of NIMV therapy in Group I patients and at least 1 year (1-5 years) after prescription of the device in Group II.
In the assessments performed 1 year after NIMV recommendation, no difference was found between groups in terms of hospital admissions. However, in Group I, intra-group analysis showed a reduction in the number of hospitalizations 1 year after NIMV. A marked reduction in PaCO(2) level was found in Group I patients 1 year after NIMV therapy. Mean survival after NIMV recommendation was 40.27 +/- 3.56 months in Group I, and 27.35 +/- 3.68 months in Group II (log rank = 7.79; p = 0.005). It was found that survival time increased as duration of NIMV usage increased.
NIMV therapy has some important and significant benefits in patients with hypercapnic chronic respiratory failure. This study has some limitations in terms of patient selection, power analysis and survival analysis. To assess the effects of NIMV on mortality and pulmonary functions, the authors believe that there is need for prospective, controlled, multicentre studies with longer follow-up periods, improved adherence and novel ventilator modes and settings.
慢性呼吸衰竭（CRF）是一种以动脉血气某些紊乱为特征的综合征。无创机械通气（NIMV）是呼吸衰竭中越来越常用的治疗方式。本研究旨在探讨 NIMV 对 CRF 患者肺功能和生存的长期影响。
该研究纳入了 170 名 CRF 患者，这些患者决定接受长期家庭机械通气。患者被分为两组-组 I（推荐使用 NIMV 且使用了 NIMV 的患者）和组 II（至少 1 年前推荐使用 NIMV 但由于各种原因未使用的患者）。从患者病历中获得推荐 NIMV 前 1 年最佳动脉血气和肺功能测试值。在组 I 患者开始使用 NIMV 治疗至少 1 年（1-5 年）后和组 II 患者处方设备至少 1 年（1-5 年）后进行相同的测试。
在推荐 NIMV 后 1 年进行的评估中，两组在住院次数方面没有差异。然而，在组 I 中，组内分析显示 NIMV 后 1 年住院次数减少。在组 I 患者中，NIMV 治疗 1 年后 PaCO2 水平明显降低。在推荐使用 NIMV 后，组 I 的平均存活时间为 40.27 +/- 3.56 个月，组 II 为 27.35 +/- 3.68 个月（对数秩检验= 7.79;p = 0.005）。发现随着 NIMV 使用时间的增加，生存时间延长。
NIMV 治疗对伴有高碳酸血症的慢性呼吸衰竭患者具有重要而显著的益处。本研究在患者选择、功效分析和生存分析方面存在一些局限性。为了评估 NIMV 对死亡率和肺功能的影响，作者认为需要进行前瞻性、对照、多中心研究，随访时间更长，依从性提高，新型通气模式和设置。
