慢性阻塞性肺疾病患者在家中接受无创通气治疗的慢性呼吸衰竭：真实世界研究。

Chronic respiratory failure in patients with chronic obstructive pulmonary disease under home noninvasive ventilation: Real-life study.

机构信息

Serviço Pneumologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.

出版信息

Pulmonology. 2018 Sep-Oct;24(5):280-288. doi: 10.1016/j.pulmoe.2018.02.007. Epub 2018 Apr 5.

DOI:10.1016/j.pulmoe.2018.02.007

PMID:29628437

Abstract

BACKGROUND

Home noninvasive ventilation (NIV) has been increasingly used in stable chronic obstructive pulmonary disease (COPD) with chronic hypercapnic respiratory failure (CHRF). However its effectiveness remains debatable.

AIM

To describe a follow-up of COPD patients under home NIV.

METHODS

Retrospective descriptive study based on a prospective 3-year database that included COPD patients under home NIV between August 2011 and July 2014.

RESULTS

Within the 334 patients initially screened, 109 (32.6%) had COPD with a mean±SD post-bronchodilator FEV1 of 38.6±14.9% predicted; age of 65.6±9.6 years. The mean±SD duration of ventilation was 63.4±51.1 months. Heterogeneous comorbidities that can contribute to CHRF were not excluded: obstructive sleep apnea and obesity were the most prevalent. Sixty-two (56.9%) patients started NIV during admission with acute respiratory failure. During follow-up there was a significant increase in mean inspiratory positive airway pressure (IPAP) and respiratory rate (19.5±4.4 vs. 23.6±5.3cmHO and 10.7±5.2 vs. 15.2±1.4 breaths/min, respectively, p<0.0001), with a significant improvement in hypercapnia (PaCO: 52.9±7.7 vs. 49.5±7.5mmHg, p<0.0001), with 93.3% of patients compliant to NIV. Admissions and days spent in hospital for respiratory illness significantly decreased after institution of NIV (respectively, 1.2±1.1 vs. 0.7±1.8 and 15.0±16.8 vs. 8.8±19.4, p<0.001). At final evaluation, patients with severe hypercapnia (n=47; PaCO ≥50mmHg) performing NIV at higher pressures (n=30; IPAP ≥25cmHO) were more compliant (10.1±3.3 vs. 6.1±3.6h/day). Three-year mortality was 24.8% (27 of 109 patients).

CONCLUSIONS

This is a real-life retrospective study in COPD patients with CHRF which results suggest benefit from home NIV. For most, NIV was effective and tolerable even at high pressures.

摘要

背景

家庭无创通气（NIV）已越来越多地用于稳定的慢性阻塞性肺疾病（COPD）合并慢性高碳酸血症性呼吸衰竭（CHRF）患者。然而，其疗效仍存在争议。

目的

描述 COPD 患者家庭 NIV 随访情况。

方法

这是一项回顾性描述性研究，基于 2011 年 8 月至 2014 年 7 月间接受家庭 NIV 的 COPD 患者的前瞻性 3 年数据库。

结果

在最初筛选的 334 名患者中，有 109 名（32.6%）患有 COPD，支气管扩张剂后 FEV1 占预计值的 38.6±14.9%；年龄为 65.6±9.6 岁。通气时间的平均值±标准差为 63.4±51.1 个月。未排除可能导致 CHRF 的混杂合并症：阻塞性睡眠呼吸暂停和肥胖症最为常见。62 名（56.9%）患者因急性呼吸衰竭入院时开始接受 NIV。随访期间，平均吸气正压气道（IPAP）和呼吸频率显著增加（分别为 19.5±4.4 比 23.6±5.3cmHO 和 10.7±5.2 比 15.2±1.4 次/分钟，p<0.0001），高碳酸血症显著改善（PaCO：52.9±7.7 比 49.5±7.5mmHg，p<0.0001），93.3%的患者对 NIV 治疗有反应。NIV 治疗后，因呼吸疾病住院的次数和住院天数明显减少（分别为 1.2±1.1 比 0.7±1.8 和 15.0±16.8 比 8.8±19.4，p<0.001）。最终评估时，47 名高碳酸血症严重患者（PaCO≥50mmHg）和 30 名接受更高压力（IPAP≥25cmHO）NIV 治疗的患者依从性更好（分别为 10.1±3.3 比 6.1±3.6 小时/天）。3 年死亡率为 24.8%（109 例患者中有 27 例）。