Nasiłowski Jacek, Szkulmowski Zbigniew, Migdał Marek, Andrzejewski Witalij, Drozd Wojciech, Czajkowska-Malinowska Małgorzata, Opuchlik Andrzej, Chazan Ryszarda
Katedra i Klinika Chorób Wewnetrznych, Pneumonologii i Alergologii, Warszawski Uniwersytet Medyczny.
Pneumonol Alergol Pol. 2010;78(6):392-8.
Home mechanical ventilation (HMV) is increasingly used in the treatment of chronic respiratory failure thanks to rapid technological development, increasing number of elderly people and extension of indications. The aim of the study was to assess: prevalence of HMV in Poland, the proportions of lung disease and neuromuscular patients using HMV and the type of interface (invasive v. non-invasive).
The questionnaire was send to all institutions providing HMV in Poland and to regional departments of National Health System (NHS).
All NHS departments responded. They reported 846 HMV users, 31% of children. The prevalence of HMV in Poland was assessed as 2,2 patient per 100.000 population without striking differences between provinces. Among 39 HMV centers in Poland 12 (31%) answered. They reported 206 patients (24% of all HMV users). Proportion of ventilation mode consisted of 59% (122 pts) treated via a tracheostomy and 41% (84 pts) with non invasive ventilation (NIV). 168 patients (82%) had neuromuscular diseases (ND), majority of them muscular dystrophy - 57 patients ( 34% of ND) and amyotrophic lateral sclerosis - 39 patients (23% of ND). There were only 38 patients (18%) with lung and thoracic cage diseases: 17 with COPD and 10 with kyphoscoliosis.
The prevalence of HMV treatment in Poland has developed dramatically in the last decade, but is still very low comparing to other European countries, especially due to very low number of patients with lung and chest wall diseases. The prevalence of invasive mode of ventilation is extremely high. The most important factors which inhibit development of HMV in Poland are: omission of respiratory physicians in the process of qualification, lack of national guidelines, sophisticated demands for HMV providers. The awareness of the need of HMV especially in patients with respiratory failure due to obesity hypoventilation syndrome and restrictive lung diseases should be increased among chest physicians.
由于技术的快速发展、老年人数量的增加以及适应症的扩大，家庭机械通气（HMV）在慢性呼吸衰竭的治疗中使用得越来越多。本研究的目的是评估：波兰HMV的患病率、使用HMV的肺部疾病和神经肌肉疾病患者的比例以及接口类型（有创与无创）。
向波兰所有提供HMV的机构以及国家卫生系统（NHS）的地区部门发送了调查问卷。
所有NHS部门都做出了回应。他们报告了846名HMV使用者，其中31%为儿童。波兰HMV的患病率估计为每10万人口中有2.2名患者，各省之间没有显著差异。在波兰的39个HMV中心中，有12个（31%）做出了回应。他们报告了206名患者（占所有HMV使用者的24%）。通气模式的比例包括59%（122例）通过气管切开术治疗，41%（84例）采用无创通气（NIV）。168名患者（82%）患有神经肌肉疾病（ND），其中大多数为肌肉萎缩症——57例（占ND的34%）和肌萎缩侧索硬化症——39例（占ND的23%）。只有38名患者（18%）患有肺部和胸廓疾病：17例慢性阻塞性肺疾病（COPD）和10例脊柱侧弯。
在过去十年中，波兰HMV治疗的患病率有了显著提高，但与其他欧洲国家相比仍然很低，特别是由于肺部和胸壁疾病患者数量非常少。有创通气模式的患病率极高。阻碍波兰HMV发展的最重要因素是：在资格认定过程中呼吸内科医生的遗漏、缺乏国家指南、对HMV提供者的复杂要求。胸部内科医生应提高对HMV需求的认识，特别是在因肥胖低通气综合征和限制性肺病导致呼吸衰竭的患者中。
