Hajian Bita, De Backer Jan, Sneyers Claire, Ferreira Francisca, Barboza Katherine C, Leemans Glenn, Vos Wim, De Backer Wilfried
Department of Respiratory Medicine, University Hospital Antwerp.
FLUIDDA nv.
Int J Chron Obstruct Pulmon Dis. 2017 Jul 28;12:2197-2205. doi: 10.2147/COPD.S136412. eCollection 2017.
Patients with severe COPD often develop chronic hypercapnic respiratory failure. Their prognosis worsens and they are more likely to develop exacerbations. This has major influence on the health-related quality of life. Currently, there is no information about the success of long-term noninvasive ventilation (NIV) among patients who receive NIV in acute settings. Also, little is known about the pathophysiological mechanism of NIV.
Ten Global Initiative for Obstructive Lung Disease stage III and IV COPD patients with respiratory failure who were hospitalized following acute exacerbation were treated with NIV using a Synchrony BiPAP device for 6 months. Arterial blood gases and lung function parameters were measured. Low-dose computed tomography of the thorax was performed and used for segmentation. Further analyses provided lobe volume, airway volume, and airway resistance, giving an overall functional description of the separate airways and lobes. Ventilation perfusion (VQ) was calculated. Patient-reported outcomes were evaluated.
PaCO significantly improved from 50.03 mmHg at baseline to 44.75 mmHg after 1 month and 43.37 mmHg after 6 months (=0.006). Subjects showed improvement in the 6-minute walk tests (6MWTs) by an average of 51 m (from 332 m at baseline to 359 m at 1 month and 383 m at 6 months). Patients demonstrated improvement in self-reported anxiety (=0.018). The improvement in image-based VQ was positively associated with the 6MWT and the anxiety domain of the Severe Respiratory Insufficiency Questionnaire.
Though previous studies of long-term NIV have shown conflicting results, this study demonstrates that patients can benefit from long-term NIV treatment, resulting in improved VQ, gas exchange, and exercise tolerance.
重度慢性阻塞性肺疾病（COPD）患者常发展为慢性高碳酸血症性呼吸衰竭。他们的预后恶化，且更易发生急性加重。这对健康相关生活质量有重大影响。目前，对于在急性情况下接受无创通气（NIV）的患者，长期NIV治疗的成功率尚无相关信息。此外，关于NIV的病理生理机制也知之甚少。
10例因急性加重住院的慢性阻塞性肺疾病全球倡议组织（Global Initiative for Obstructive Lung Disease）III期和IV期呼吸衰竭患者，使用同步双水平气道正压通气（BiPAP）设备进行NIV治疗6个月。测量动脉血气和肺功能参数。进行胸部低剂量计算机断层扫描并用于分割。进一步分析得出肺叶体积、气道体积和气道阻力，对各个气道和肺叶进行整体功能描述。计算通气灌注（VQ）。评估患者报告的结局。
动脉血二氧化碳分压（PaCO）从基线时的50.03 mmHg显著改善至1个月后的44.75 mmHg和6个月后的43.37 mmHg（P=0.006）。受试者在6分钟步行试验（6MWT）中的表现平均改善了51米（从基线时的332米提高至1个月时的359米和6个月时的383米）。患者自我报告的焦虑症状有所改善（P=0.018）。基于图像的VQ改善与6MWT以及严重呼吸功能不全问卷的焦虑领域呈正相关。
尽管先前关于长期NIV的研究结果相互矛盾，但本研究表明患者可从长期NIV治疗中获益，从而改善VQ、气体交换和运动耐力。
