新加坡成人专用家庭通气与呼吸支持服务的使用模式及生存结局：一项7年回顾性观察队列研究
The pattern of use and survival outcomes of a dedicated adult Home Ventilation and Respiratory Support Service in Singapore: a 7-year retrospective observational cohort study.
作者信息
Tan Geak Poh, Soon Lydia Hse Yin, Ni Bin, Cheng Hong, Tan Adrian Kok Heng, Kor Ai Ching, Chan Yeow
机构信息
Department of Respiratory and Critical Care Medicine, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
出版信息
J Thorac Dis. 2019 Mar;11(3):795-804. doi: 10.21037/jtd.2019.02.18.
BACKGROUND
In Singapore, a dedicated adult multidisciplinary Home Ventilation and Respiratory Support Service (HVRSS) was set-up to assist individuals with chronic ventilatory failure. We aimed to study the use, survival outcomes and identify factors influencing survival in our cohort of ventilator-assisted individuals (VAIs).
METHODS
We retrospectively reviewed all referrals to HVRSS from 2009 to 2015. All VAIs were included and divided into 4 categories: (I) amyotrophic lateral sclerosis (ALS); (II) other neuromuscular and chest wall disease (NMCW); (III) spinal cord injury (SCI); and (IV) complex intensive care unit (ICU) groups for comparison of baseline characteristics, co-morbidities, therapy details and survival outcomes. Cox proportional analysis was used to identify important factors influencing survival for ALS and non-ALS VAIs.
RESULTS
There were 112 VAIs; most were male (63%) and ethnic Chinese (83%). At baseline, median [interquartile range (IQR)] age was 61 [46-69] years, body mass index was 20.2 (17.1-23.8) kg/m and forced vital capacity was 38 [24-65] %predicted. The three most common diseases were ALS (43%), SCI (13%) and congenital muscular dystrophies (6%). Seventy-four (66%) VAIs received non-invasive ventilation (NIV). Median survival for ALS, Complex ICU, SCI and NMCW VAIs were 1.8, 2.6, 4.2 and 6.7 years respectively. In ALS, NIV conversion to invasive mechanical ventilation (IMV) was associated with longer survival [hazard ratio (HR) 0.24]. In non-ALS VAIs, older age (HR 1.40) and cardiovascular comorbidities (HR 2.61) were poor prognostic factors.
CONCLUSIONS
The HVRSS managed a heterogenous group of VAIs in Singapore and survival is comparable to published cohorts. ALS had the worst survival whereas NMCW had the best survival with Complex ICU and SCI groups in between. Transition from NIV to IMV, age and cardiovascular disease were important prognostic factors.
背景
在新加坡，专门设立了一个成人多学科家庭通气与呼吸支持服务（HVRSS），以协助慢性呼吸衰竭患者。我们旨在研究呼吸机辅助患者（VAIs）队列中该服务的使用情况、生存结局，并确定影响生存的因素。
方法
我们回顾性分析了2009年至2015年所有转诊至HVRSS的患者。纳入所有VAIs患者，并将其分为4类：（I）肌萎缩侧索硬化症（ALS）；（II）其他神经肌肉和胸壁疾病（NMCW）；（III）脊髓损伤（SCI）；（IV）复杂重症监护病房（ICU）组，以比较基线特征、合并症、治疗细节和生存结局。采用Cox比例分析确定影响ALS和非ALS VAIs患者生存的重要因素。
结果
共有112例VAIs患者；大多数为男性（63%），华裔（83%）。基线时，年龄中位数[四分位间距（IQR）]为61[46 - 69]岁，体重指数为20.2（17.1 - 23.8）kg/m²，用力肺活量为预测值的38[24 - 65]%。三种最常见的疾病为ALS（43%）、SCI（13%）和先天性肌营养不良（6%）。74例（66%）VAIs患者接受了无创通气（NIV）。ALS、复杂ICU、SCI和NMCW VAIs患者的中位生存期分别为1.8年、2.6年、4.2年和6.7年。在ALS患者中，NIV转换为有创机械通气（IMV）与更长的生存期相关[风险比（HR）0.24]。在非ALS VAIs患者中，年龄较大（HR 1.40）和有心血管合并症（HR 2.61）是不良预后因素。
结论
新加坡的HVRSS管理了一组异质性的VAIs患者，其生存情况与已发表的队列研究相当。ALS患者的生存期最差，而NMCW患者的生存期最好，复杂ICU和SCI组介于两者之间。从NIV转换为IMV、年龄和心血管疾病是重要的预后因素。
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