Tsuboi T, Ohi M, Chin K, Noguchi T, Kita H, Otsuka N, Sekino H, Murao H, Kuriyama T, Kuno K
Department of Clinical Physiology, Kyoto University, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1996 Sep;34(9):959-67.
Nasal intermittent positive pressure ventilation (NIPPV) is widely used in domiciliary treatment of chronic ventilatory disorders. The outcomes of long-term NIPPV were analyzed in 41 patients with hypercapnic respiratory failure due to pulmonary tuberculosis sequelae (PTS; n = 17), neuromuscular disease (NMD; n = 8), kyphoscoliosis (KS; n = 7), chronic obstructive pulmonary disease (COPD; n = 6), and miscellaneous diseases (n = 3). Twenty-seven patients with chronic conditions but without acute exacerbations began receiving NIPPV, and fourteen patients began receiving NIPPV after an acute exacerbation. Outcome measures included the probability of continuing NIPPV, survival after starting NIPPV, survival after starting home oxygen therapy (HOT), arterial blood gases, nocturnal oxygen saturation, pulmonary function, and the number of hospital days. Two patients with PTS died, 7 and 40 months after starting NIPPV. Two patients (one with PTS and one with COPD) switched from NIPPV to intermittent positive pressure ventilation via a tracheostomy. The condition of one patient with NMD improved and NIPPV was discontinued. The three-year and five-year probabilities of continuing NIPPV in all patients were 82%, and 71%, respectively. The survival rates three and five years after starting NIPPV were 97% and 85%, respectively. The survival rates one to nine years, and ten to eleven years after starting HOT were 98% and 65%, respectively. The arterial PO2 and PCO2, nocturnal oxygen saturation, vital capacity, and forced expiratory volume, in one second all improved after NIPPV was begun. NIPPV also reduced the number of hospital days, particularly in patients with KS. In conclusion, the long-term outcome of NIPPV in patients with hypercapnic respiratory failure is encouraging.
鼻间歇正压通气（NIPPV）广泛应用于慢性通气障碍的家庭治疗。对41例因肺结核后遗症（PTS；n = 17）、神经肌肉疾病（NMD；n = 8）、脊柱后凸（KS；n = 7）、慢性阻塞性肺疾病（COPD；n = 6）和其他杂病（n = 3）导致的高碳酸血症呼吸衰竭患者的长期NIPPV治疗结果进行了分析。27例慢性病但无急性加重的患者开始接受NIPPV治疗，14例患者在急性加重后开始接受NIPPV治疗。观察指标包括继续使用NIPPV的概率、开始NIPPV后的生存率、开始家庭氧疗（HOT）后的生存率、动脉血气、夜间氧饱和度、肺功能以及住院天数。2例PTS患者在开始NIPPV治疗后7个月和40个月死亡。2例患者（1例PTS患者和1例COPD患者）从NIPPV改为经气管造口的间歇正压通气。1例NMD患者病情改善，停止使用NIPPV。所有患者继续使用NIPPV的三年和五年概率分别为82%和71%。开始NIPPV治疗后三年和五年的生存率分别为97%和85%。开始HOT治疗后1至9年和10至11年的生存率分别为98%和65%。开始NIPPV治疗后，动脉PO2和PCO2、夜间氧饱和度、肺活量和一秒用力呼气量均有所改善。NIPPV还减少了住院天数，尤其是KS患者。总之，NIPPV治疗高碳酸血症呼吸衰竭患者的长期效果令人鼓舞。
