Toujani S, Dabboussi S, Snene H, Mjid M, Kamoun S, Hedhli A, Cheikh Rouhou S, Cheikh R, Beji M, Ouahchi Y, Cherif J
Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie.
Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital Militaire, Tunis, Tunisie.
Rev Pneumol Clin. 2018 Sep;74(4):235-241. doi: 10.1016/j.pneumo.2018.03.007. Epub 2018 Apr 9.
The benefits of long-term non-invasive ventilation (NIV) in the management of chronic obstructive pulmonary disease (COPD) patients remain controversial.
To analyze the characteristics of COPD patients under home NIV and to evaluate its impact among this population.
We carried out a retrospective study between January 2002 and April 2016 of COPD patients under long-term NIV at "la Rabta" and the Military Hospital.
There were 27 patients with an average age of 64 and a sex ratio (M/F) of 0.92. Active smoking was reported in 96.3%. A persistent hypercapnia following an acute exacerbation of COPD with failure to wean the NIV was the main indication of long-term NIV. We noted a reduction in hospital admissions in the first year of 60% and in intensive care of 83.3% (P<10). There was no non-significant decrease of PaCO (4.5mmHg). There was no modification in FEV 1 and in FVC (P>0.05). The survival rate was 96.3% at 1 year, 83.3% at 2 years and a median survival of 24 months.
Our study suggests that home NIV contributes to the stabilization of some COPD patients by reducing the hospitalizations rates for exacerbation. More prospective studies are needed to better assess the impact of NIV on survival and quality of life and to better define the COPD patients who require NIV.
长期无创通气（NIV）在慢性阻塞性肺疾病（COPD）患者管理中的益处仍存在争议。
分析接受家庭无创通气的COPD患者的特征，并评估其在该人群中的影响。
我们对2002年1月至2016年4月期间在“拉卜塔”医院和军事医院接受长期无创通气的COPD患者进行了一项回顾性研究。
共有27例患者，平均年龄64岁，性别比（男/女）为0.92。96.3%的患者有主动吸烟史。COPD急性加重后持续高碳酸血症且无创通气撤机失败是长期无创通气的主要指征。我们注意到第一年住院次数减少了60%，重症监护次数减少了83.3%（P<0.01）。动脉血二氧化碳分压（PaCO₂）无显著下降（4.5mmHg）。第1秒用力呼气容积（FEV₁）和用力肺活量（FVC）无变化（P>0.05）。1年生存率为96.3%，2年生存率为83.3%，中位生存期为24个月。
我们的研究表明，家庭无创通气通过降低急性加重的住院率有助于部分COPD患者病情稳定。需要更多前瞻性研究来更好地评估无创通气对生存率和生活质量的影响，并更好地确定需要无创通气的COPD患者。
