Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine , Ostmerheimer Strasse 200, 51109, Cologne, Germany.
Institute for Research in Operative Medicine, Faculty of Health - School of Medicine, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany.
BMC Pulm Med. 2021 Aug 3;21(1):255. doi: 10.1186/s12890-021-01621-4.
Research on health-related quality of life (HRQL) has become increasingly important in recent decades. However, the impact of both living conditions and the level of autonomy impairments on HRQL in COPD patients receiving non-invasive ventilation (NIV) is still unclear.
The Severe Respiratory Insufficiency Questionnaire (SRI) was used to measure HRQL in a prospective cohort of COPD patients in whom home NIV was already established. Data on sociodemographics, clinical characteristics and standardized levels of autonomy impairment were evaluated. A multiple linear regression analysis was performed to identify the factors associated with a reduced HRQL.
A total of 137 patients (67.0 ± 7.8 years, 45% female) were assessed. The mean SRI Summary Score was 54.1 ± 16.9 (95%CI: 51.1-57.1; N = 127). Regular ambulatory care was provided in 76% of patients, but only 37% underwent pulmonary rehabilitation. Overall, 69% of patients lived with family members, while 31% lived alone (family situation). Autonomy impairment levels were most serious in 3%, serious in 14%, and significant in 29% of patients, while 54% had no impairments at all. Of note, higher levels of autonomy impairment were markedly associated with lower SRI scores (regression coefficient - 6.5 ± 1.1 per level; P < 0.001). In contrast, family situation (0.2 ± 3.0; P = 0.959), ambulatory care by a respiratory specialist (1.7 ± 3.6; P = 0.638), and pulmonary rehabilitation (- 0.8 ± 3.1; P = 0.802) did not appear to influence HRQL. Possible subgroup effects were evident for the factors "impaired autonomy" and "living in a nursing home" (P = 0.016).
A higher level of autonomy impairment has been identified as the major determinant of reduced HRQL in COPD-patients receiving long-term NIV, particularly in those living in a nursing home. Trial Registration German Clinical Trials Register (DRKS00008759).
近年来，健康相关生活质量（HRQL）的研究变得越来越重要。然而，在接受无创通气（NIV）的 COPD 患者中，生活条件和自主损害程度对 HRQL 的影响仍不清楚。
使用严重呼吸不足问卷（SRI）前瞻性评估已建立家庭 NIV 的 COPD 患者的 HRQL。评估社会人口统计学、临床特征和标准化自主损害程度的数据。进行多元线性回归分析，以确定与 HRQL 降低相关的因素。
共评估了 137 例患者（67.0±7.8 岁，45%为女性）。SRI 综合评分的平均值为 54.1±16.9（95%CI：51.1-57.1；N=127）。76%的患者接受常规门诊护理，但仅有 37%的患者接受了肺康复治疗。总体而言，69%的患者与家人一起生活，而 31%的患者独居（家庭情况）。自主损害程度严重的患者占 3%，严重的占 14%，显著的占 29%，而无损害的占 54%。值得注意的是，自主损害程度越高，SRI 评分越低（每级下降 6.5±1.1；P<0.001）。相比之下，家庭情况（0.2±3.0；P=0.959）、呼吸专科门诊护理（1.7±3.6；P=0.638）和肺康复治疗（-0.8±3.1；P=0.802）似乎并未影响 HRQL。“自主损害”和“居住在疗养院”这两个因素存在明显的亚组效应（P=0.016）。
自主损害程度较高是接受长期 NIV 的 COPD 患者 HRQL 降低的主要决定因素，尤其是居住在疗养院的患者。
德国临床试验注册（DRKS00008759）。
