Comer D M, Oakes A, Mukherjee R
Consultant Respiratory/Sleep Physician, Birmingham Heartlands Hospital, Birmingham, B9 5SS.
Ulster Med J. 2015 Jan;84(1):22-5.
To determine if the long terms effects of non-invasive home mechanical ventilation (NIHMV) in the elderly are as beneficial as in younger subjects for a dedicated non-invasive ventilation unit in a tertiary referral hospital within the UK.
The study population included 256 patients who were successfully established on NIHMV between May 2009 and August 2013. Patients were divided into three groups according to age: group 1 (n=103) ≥75; group 2 (n=81) 65 -74; and group 3 (n=72) < 65 years of age. Initial assessments, both prior to starting NIHMV and at 12 month follow up were determined which included establishing the primary cause of respiratory insufficiency, measurement of arterial blood gas parameters, spirometry, overnight oximetry, and sniff nasal inspiratory pressure (SNIP) in those patients with neuromuscular disease. The number of hospital admissions in the year prior to starting NIHMV, and in the subsequent year, along with the number of days spent as an inpatient were ascertained as a measure of burden to local health care resources. Compliance with NIV at follow up, facilitated by recorded data within the ventilator software, was established along with an assessment of any reported side effects.
Group 3 had the most profound abnormalities in lung function and blood gas parameters at initial assessment with a trend towards a higher number of acute admissions. In absolute terms, there was a greater decline in the number of admissions for subjects in group 2 after being established on NIHMV. Although more subjects in group 3 had chest wall deformities, COPD or bronchiectasis, this group had the lowest number of subjects with neuromuscular disease. Improvements in gas exchange were most pronounced for group 3 subjects despite no significant differences in the selected ventilator settings across the 3 groups. For neuromuscular patients, when measured, SNIP pressures were lowest in group 3.
NIHMV was effective and tolerated for all three age groups. There was an improvement in measured patient centred endpoints across all three age groups, all of whom benefited equally.
在英国一家三级转诊医院中，确定无创家庭机械通气（NIHMV）对老年人的长期影响是否与对年轻受试者一样，对专门的无创通气设备有益。
研究人群包括2009年5月至2013年8月期间成功接受NIHMV治疗的256例患者。根据年龄将患者分为三组：第1组（n = 103）≥75岁；第2组（n = 81）65 - 74岁；第3组（n = 72）< 65岁。在开始NIHMV之前以及随访12个月时进行了初始评估，包括确定呼吸功能不全的主要原因、测量动脉血气参数、肺活量测定、夜间血氧饱和度测定，以及对患有神经肌肉疾病的患者测量嗅鼻吸气压力（SNIP）。确定开始NIHMV之前一年以及随后一年的住院次数，以及住院天数，以此作为衡量当地医疗资源负担的指标。通过呼吸机软件中的记录数据确定随访时对无创通气的依从性，并评估任何报告的副作用。
在初始评估时，第3组的肺功能和血气参数异常最为严重，急性入院次数有增加趋势。从绝对值来看，第2组患者在接受NIHMV治疗后入院次数下降幅度更大。尽管第3组中患有胸壁畸形、慢性阻塞性肺疾病（COPD）或支气管扩张的患者更多，但该组中患有神经肌肉疾病的患者数量最少。尽管三组所选的通气设置无显著差异，但第3组患者的气体交换改善最为明显。对于神经肌肉疾病患者，测量时第3组的SNIP压力最低。
NIHMV对所有三个年龄组均有效且耐受性良好。所有三个年龄组以患者为中心的测量终点均有改善，且所有年龄组获益相同。
