Clinical Study Of Long-Term Domiciliary Nippv In The Treatment Of COPD

ObjectiveTo investigate the effect of domiciliary non-invasive positive pressure ventilation(NIPPV) in the treatment of chronic obstructive pulmonary disease(COPD).Materials and Methods1.Subjects:Accord to the diagnostic criteria of chronic obstructive pulmonary disease, collecting 96 patients with severe COPD that treated with long-term oxygen therapy and had NIPPV more than 12 months.2. Research approach:Questionnaire,phone call following-up on and relevant examinations for free were adopted in our study. Compared items before and after 1 year the NIPPV used which include the following:2.1. Base-line information:age, sex, FEV1, PH,PaCO2,PaO2,complications, BMI(Kg/m2),drugs-treatment.2.2. Quality of life:St.George Questionnaire was used for assess.2.3. Functional dyspnea can be assessed by the Medical Research Council dyspnea scale as follows.0:not troubled with breathlessness except with strenuous exercise.1:troubled by shortness of breath when hurrying or walking up a slight hill. 2:walks slower than people of the same age due to breathlessness or has to stop for breath when walking at own pace on the level.3:stops for breath after walking about 100 m or after a few minutes on the level.4:too breathless to leave the house or breathless when dressing or undressing.2.4. Hospitalization costs and number of admission:compared hospitalization costs and number of admission in 1 year before and after ventilator used. 2.5. Taken notes on the pulmonary function and blood gas analysis (before COPD treated, after NIPPV used 6 months and 12 months separately).2.6. Breathing machine:type, IPAP,EPAP, used time, alarm setting et al.2.7. Following-up visit:phone call following-up were done every 3 months. Relevant tests were done after NIPPV used 6 and 12 months in local hospital,then record the symptoms, signs, deterioration and number of admission.2.8. Obedience:Patients who used NIPPV＜=3.5h/d were supposed to have no obedience.2.9. Observe the side effects and solutions during the ventilator used.2.10.Survival rate was determined by life span table.3. Spss13.0 was used for statistic analysis and significant difference was undertaken with a=0.05 as the test standard.Results1. General conditions of the patients:There were 12 patients who had no obedience ruled out. The efficacy 84 patients in the trail including 46 males and 38 females,73 typeⅡRF and 11 typeⅠRFpatients. Their age ranged 46-76 years (61.7±7.4),the FEV1 was 0.72～1.20L(0.96±0.13), BMI was 19～44(29.7±6.18), 72 patients inhaled glucocorticoids and LABA.2. Integration for quality of life was 63.6±7.5 compared to 71.2±8.7 one year before NIPPV used; P＜0.05.3. Grade of dyspnea was 2.44±0.62 compared to 3.02±0.53 one year before NIPPV used; P＜0.05.4. The hospital administration was 1.72±0.86 compared to 2.49±0.87 one year before NIPPV used, P＜0.01.5. The medical cost in 1 year after NIPPV was 2.64±1.02(wanyuan RMB) compared to 3.09±0.85(wanyuan RMB) before; P＜0.05.6.Pulmonary function:FEV1(L) before NIPPV was 0.96±0.13, after NIPPV used 6 months was 1.03±0.16(p＜0.05),after NIPPV used 12 months was 1.01±0.15,P＞0.05 compared to 6 months before.7.Blood gas analysis:PH, PO2 (mmHg),PCO2 (mmHg) before treatment were 7.291±0.046,53.9±3.9,62.1±6.3, after NIPPV used 6 months were 7.324±0.041, 62.8±4.3,55.7±5.0,P＜0.01 compared to before. After NIPPV used 12 months were 7.321±0.038,64.1±4.5,57.0±5.3, P＞0.05 compared to NIPPV used 6 months.8.Obedience:There were 84 in 96 patients used NIPPV more than 3.5h/d, the rate of obedience was 87.5%.9.70 patients had uncomfortable feelings during NIPPV used such as ventosity, thirst, chest distress et al. This mainly related to side effects due to unskilled operation of ventilator.10.9 patients died during our study, survival rate of 1 year is 90.0%.11.There are some problems during the use of NIPPV:the follow-up did not do well;patients cannot turning parameter as the condition variety or deal with the side effects; there were not effective alarm settings and so on.Conclusion1.Domiciliary NIPPV can improve the pulmonary function and blood gas analysis. The dyspnea of patients had a favourable turn.Hospital administration and medical cost decreased significantly and quality of life improved. NIPPV can be accepted by patients preferable and it is an effective method for COPD.2. Domiciliary NIPPV was a convenient way for COPD patients, which can improve patients'obedience to some extent. But there are still some problems:we should improve the doctors' usage level of ventilators and follow-up timely to solute patients' problems to improve the effectiveness of NIPPV.3.So far,there is no enough evidence to determine NIPPV's function on prolong existence of COPD patients and we still need large sample and multi-centre study. However, NIPPV appears to be the most important new modality in reducing the mortality of COPD patients.