期刊報告 : 洪琪馥 2012 - 9 - 5

兩年期慢性肺病病人在家夜間使用非侵入性通氣合併肺部復健：一個隨機對照試驗

Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients: A randomized controlled trial

Marieke L Duiverman, Johan B Wempe, Gerrie Bladder, Judith M Vonk, Jan G Zijlstra, Huib AM Kerstjens and Peter J Wijkstra..

Respiratory Research 2011, 12:112-122

報 告 者 : 洪琪馥

指 導 者 : 鄭瑞駿
報告日期 : 2012 - 9 - 5

背景

由於缺少長期數據，慢性高碳血症呼吸衰竭之阻塞性肺部疾病(COPD)患者間歇使用非侵入性正壓通氣(NIPPV)仍有爭議。

本研究目的是在比較兩年期慢性高碳血症呼吸衰竭之COPD患者在家夜間間歇使用非侵入性通氣合併肺部復健和單獨使用肺部復健治療(PR)結果。

方法

對66位病人在家使用兩年的追蹤進行分析。使用截距隨機效應之線性混合效應模式與以及基準值的調整評估非侵入性正壓呼吸器(NIPPV)加上肺部復健(PR)治療和單獨使用肺部復健治療(PR)之間的差異。主要結果為健康相關生活品質( HRQoL)；次要結果是情緒狀態，呼吸困難，氣體交換，功能狀況，肺功能，以及惡化頻率。

結果

比較單獨使用肺部復健治療(PR)和合併非侵入性正壓通氣(NIPPV)並沒明顯改善慢性呼吸問卷量表(CRQ)( 群組間平均差異變化為-1.3分【 95％CI：-9.7～7.4 】)，使用Maugeri呼吸衰竭問卷量表評估顯示肺部復健治療(PR)合併非侵入性正壓通氣(NIPPV)可改善健康相關生活品質 (HRQoL) (-13.4％【-22.7 ～ -4.2；p=0.005】)，情緒狀態(醫院焦慮和憂鬱量表-4.0【-7.8～0.0；p=0.05】)，呼吸困難分數(醫學研究委員會MRC -0.4【-0.8 ～-0.0；p=0.05】)，日間動脈血液氣體(PaCO2：-0.4 KPa【-0.8～-0.2；p=0.01】；PaO2：0.8 KPa【 0.0～1.5；P=0.03】)，6分鐘步行距離 (77.3公尺【46.4～108.0；P＜0.001】)，Groningen 活動和限制量表(-3.8【-7.4～-0.4；p=0.03】)，和第一秒用力吐氣容積FEV1 (115ml【19～211；p=0.019】)，惡化率頻沒有改變。

結論

慢性高碳血症呼吸衰竭COPD患者使用非侵入性通氣合併肺部復健兩年可改善健康相關生活品質( HRQoL)，情緒狀態，呼吸困難，氣體交換，運動耐受力和肺功能衰退，好處可隨時間增加。

The ACIF(Acute Care Index of Function)(急性照護功能指數) would be appropriate for the acute care neurological setting, index items were chosen and defined by experienced physical therapists involved in the assessment and treatment of patients with acute neurological disorders.

圖片來源：Physical Therapy 1988,68,1102-1108.

The mental status items were included to improve the instrument's ability to separate the patients by score into groups consistent with discharge placement. Mental status items are rated as either "yes" or "no" according to the presence or absence of the defined behavior.

The remaining three subsets address the patient's ability to perform various gross motor activities (Fig. 1). The 16 items within these three subsets were selected specifically for use with patients with acute neurologic disorders. Items with a low level of difficulty (eg, bed mobility) were included because we believed

that patients with acute neurologic disorders would demonstrate change in their ability to perform these

activities.

1. Unable—Patient cannot physically assist to perform the activity.

2. Dependent—Patient assists to perform the activity but requires physical or verbal assistance to complete

the activity.

3. Independent—Patient performs the activity meeting all stated criteria without verbal or physical assistance.

The rating "unable" a score of 0, "dependent" a score of 1, and "independent" a score of 2.

Rate of perceived exertion (Borg Scale)

用於一般運動強度訓練或用於吸氣肌肉強度訓練


圖片來源：http://www.huffandbuff.com/2010/07/08/exercise-exertion-talk-test/

一般吸氣肌肉訓練時，自覺式呼吸費力指數(Borg Scale) 達到7分以上就要停止。

SF-36 健康生活品質量表，測量受試者對自己身心健康的看法，為一般性的心理測量工具，非針對特定的年齡、疾病或治療而設計。

原著作者：Dr. John Ware, 1996委由長庚大學盧瑞芬副教授負責台灣版使用授權，信效度介於0.62-0.96之間。

量表分為八個概念：

1.physical functioning
2.impact of physical health on role performance(role-physical)
3.pain
4.health perceptions
5.vitality
6.social functioning
7.mental health
8.impact of emotional health on role performance (role-emotional)

每個概念的分數從0-100，分數愈高，身體健康狀態愈好。

SF-36 健康生活品質量表(原版)：

American translation, modification, and validation of the St. George's Respiratory Questionnaire. Clin Ther. 2000 Sep;22(9):1121-45.

SF-36 健康生活品質量表計分方式。

一、ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION(APACHE II)  scoring system
總分 0-71分

二、simplified acute physiology score (SAPS)：總分0-163分

三、Average scores in comparison between survivors and non-survivors 

     J Korean Med Sci 2009;24:420-6

四、SAPS II scores of our patients and their outcome results.

     JIACM 2006;7(3):202-5

期刊報告-101.8-廖文慧


Early use of noninvasive positive pressure ventilation for acute lung injury: A multicenter randomized controlled trial

Objective: Noninvasive positive pressure ventilation is beneficial for patients with acute respiratory failure. However, its possible benefit for patients with acute lung injury (200 mm Hg <PaO2/FIO2 <300 mm Hg) remains unclear. Our aim was to assess the safety and efficacy of noninvasive positive pressure ventilation for patients with acute lung injury and compare this with high-concentration oxygen therapy.

Design: A multicentered randomized controlled trial.

Setting: Ten multipurpose intensive care units.

Patients: Forty patients who fulfilled the criteria for acute lung injury were included in this study.

Interventions: Patients were randomly allocated to receive either noninvasive positive pressure ventilation (noninvasive positive pressure ventilation group) or high-concentration oxygen therapy through a Venturi mask (control group).

Measurements and Main Results: Twenty-one patients were assigned to the noninvasive positive pressure ventilation group and 19 were in the control group. At study entry, the patients’ characteristics in the two groups were similar. Noninvasive positive pressure ventilation application decreased the respiratory rate and improved PaO2/FIO2 with time. The proportion of patients requiring intubation and the actual number of intubations in the noninvasive positive pressure ventilation group were significantly less than in the control group (one of 21 vs. seven of 19; p=.02, and one of 21 vs. four of 19; p = .04, respectively). Noninvasive positive pressure ventilation showed a trend for reducing inhospital mortality (one of 21 vs. five of 19; p = .09). The total number of organ failures in the noninvasive positive pressure ventilation group was significantly lower than in the control group (three vs. 14; p < .001).

Conclusions: Noninvasive positive pressure ventilation is safe for selected patients with acute lung injury. However, a larger randomized trial with need for intubation and mortality as the outcomes of interest is required. (Crit Care Med 2012; 40: 455–460)

KEY WORDS: acute lung injury; acute respiratory distress syndrome; endotracheal intubation; noninvasive positive pressure ventilation; randomized controlled trial

無插管病人的意識評估可用Glasgow coma scale; 插管病人可用此The Kelly-Matthay scale來評估病人的意識狀態。

Source from: Kelly BJ, Matthay MA: Prevalence and severity of neurologic dysfunction in critically ill patients. Influence on need for continued mechanical ventilation. Chest 1993; 104:1818–1824.