摘要
支气管扩张导致的慢性呼吸衰竭患者的预期寿命和生活质量较差。慢性阻塞性肺疾病夜间鼻腔间歇正压通气(NIPPV)的适应症仍有争议。本研究的目的是确定一些家庭机械通气的目标,即改善血气值和减少住院时间,实现了NIPPV和氧+治疗慢性呼吸衰竭患者由于支气管扩张。连续16例患者(女性12例,男性4例;平均年龄57 +/- 11岁),因支气管扩张导致的慢性呼吸衰竭,除氧治疗外,在家中使用夜间NIPPV治疗,回顾性研究了NIPPV前后血气值和住院时间。记录每位患者接受治疗的细节。9名患者同意完成一份问卷,以确定他们对这种治疗的好处的看法。使用容量呼吸器进行NIPPV,并使用定制的硅胶膏模型鼻面罩。NIPPV平均使用26个月(范围0.5-60个月)。11例患者在使用NIPPV后12个月存活。 No significant improvement in blood gas values was noted on room air during NIPPV, but arterial carbon dioxide tension (Pa,CO2) stabilized after the period of worsening observed before initiation of NIPPV. Duration of hospitalization, the year before and the year after NIPPV, was 19 (3-40) and 16 (8-37) days, respectively (NS). For the 11 patients who were alive 2 yrs after the start of NIPPV, duration of hospitalization the year before NIPPV and between 12 and 24 months after NIPPV were 17 (4-40) and 7 (2-27) days, respectively (p < 0.05). Nine patients who had received NIPPV for at least 12 months at the time of the study reported an improvement in their quality of life. The results suggest that home ventilatory support by nasal intermittent positive pressure ventilation offers an acceptable alternative to tracheotomy, with less discomfort, in the management of severe respiratory failure due to bronchiectasis, in order to allow the patient to return home. These results should be confirmed by controlled studies.