Jones S E, Packham S, Hebden M, Smith A P
Chest Department, Llandough Hospital & Community NHS Trust, Penarth, South Glamorgan, UK.
Thorax. 1998 Jun;53(6):495-8. doi: 10.1136/thx.53.6.495.
There is increasing interest in the use of non-invasive nocturnal intermittent positive pressure ventilation (NIPPV) in the management of patients with chronic hypercapnoeic (type II) respiratory failure. Although this treatment enables patients requiring mechanical ventilatory support to the treated more readily at home, few studies have been done to demonstrate its long term benefits in chronic obstructive pulmonary disease (COPD) and the application of NIPPV in these circumstances remains controversial.
Eleven patients in severe stable chronic type II respiratory failure due to COPD who were unresponsive to conventional treatments experienced symptomatic hypercapnia when receiving sufficient supplementary oxygen to result in an arterial oxygen saturation (SaO2) of > 90%. They were assessed for treatment with NIPPV, and its effects were observed for over two years using arterial blood gas tensions, spirometric parameters and body mass index (BMI), survival, hospital admissions, use of general practitioner resources, and patient satisfaction.
Hospital admissions and GP consultations were halved after one year compared with the year before NIPPV and there was a sustained improvement in arterial blood gas tensions at 12 and 24 months when breathing air, despite progressive deterioration in ventilatory function. BMI did not change during the period of observation. The median survival was 920 days, with no patient dying within the first 500 days.
Domiciliary NIPPV results in improvements in arterial blood gas tensions which are sustained after two years of treatment and reduces both hospital admissions and general practitioner visits by patients with severe COPD in hypercapnoeic respiratory failure. It is well tolerated and, although there was no control group, survival appears to be prolonged when these results are compared with those of the NOTT and MRC (LTOT) trials.
无创夜间间歇正压通气（NIPPV）在慢性高碳酸血症（II型）呼吸衰竭患者管理中的应用越来越受到关注。尽管这种治疗使需要机械通气支持的患者能够更方便地在家中接受治疗，但很少有研究证明其在慢性阻塞性肺疾病（COPD）中的长期益处，且NIPPV在这些情况下的应用仍存在争议。
11例因COPD导致严重稳定的慢性II型呼吸衰竭且对传统治疗无反应的患者，在接受足够的补充氧气以使动脉血氧饱和度（SaO2）>90%时出现症状性高碳酸血症。对他们进行NIPPV治疗评估，并使用动脉血气张力、肺功能参数和体重指数（BMI）、生存率、住院次数、全科医生资源利用情况以及患者满意度观察其两年多的效果。
与NIPPV治疗前一年相比，一年后住院次数和全科医生会诊次数减半，尽管通气功能逐渐恶化，但在呼吸空气时12个月和24个月时动脉血气张力持续改善。观察期间BMI没有变化。中位生存期为920天，在前500天内没有患者死亡。
家庭使用NIPPV可使动脉血气张力得到改善，经过两年治疗后仍能持续，减少了重度COPD合并高碳酸血症呼吸衰竭患者的住院次数和全科医生就诊次数。它耐受性良好，尽管没有对照组，但与NOTT和MRC（LTOT）试验的结果相比，生存率似乎有所延长。
