Efficacy of home noninvasive positive pressure ventilation on patients with severe stable chronic obstructive pulmonary disease in China: a meta-analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Ye ¹ ,  FU Qizhi ¹ , DAI Bing ² , ZHANG Jianqiang ¹

1. Intensive Care Unit, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, P. R. China;
2. Department of Respiratory Medicine, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P. R. China;

Corresponding?author：

FU Qizhi, Email: fuqizhi33@sina.com

Keywords：

Chronic obstructive pulmonary disease; Noninvasive positive pressure ventilation; Meta-analysis

DOI：

10.7507/1671-6205.201804045

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Objective To systematically evaluate the efficacy of home noninvasive positive pressure ventilation (HNPPV) on patients with severe stable chronic obstructive pulmonary disease in China. Methods Systematic literature search was performed in Chinese BioMedical Literature Database, WanFang Data, VIP Database, Chinese National knowledge Infrastructure databases from inception to January 2018. All randomized controlled trials (RCTs) that reported comparison of the efficacy of HNPPV on patients with severe stable chronic obstructive pulmonary disease were included. All related data were extracted. Meta-analysis was conducted using the statistical software RevMan 5.3 on the basis of strict quality evaluation. Results A total of 767 patients from 14 studies were included in this meta-analysis. The combined results showed that, compared with the control group, HNPPV could significantly reduce the mortality (relative risk 0.51, 95%CI 0.33 – 0.78, P=0.002) and PaCO₂ ［weighted mean difference (MD) –10.78, 95%CI –13.17 – –8.39, P<0.000 01］ of patients, improve the levels of PaO₂ (MD 7.84, 95%CI 5.81 – 9.87, P<0.000 01), FEV₁ (MD 0.13, 95%CI 0.08 – 0.18, P<0.000 01), and the quality of life (MD –6.27, 95% CI –9.04 – –3.51, P<0.000 01). Conclusion HNPPV can reduce the mortality of patients, improve the gas exchange, pulmonary function and the quality of life, but more large sample, high-quality, and multicenter RCT studies are needed.

Citation： LIU Ye, FU Qizhi, DAI Bing, ZHANG Jianqiang. Efficacy of home noninvasive positive pressure ventilation on patients with severe stable chronic obstructive pulmonary disease in China: a meta-analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(3): 209-216. doi: 10.7507/1671-6205.201804045 Copy

1.	GOLD Executive Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (Updated 2018). Available at: http://goldcopd.org/..
2.	Gea J, Agustí A, Roca J. Pathophysiology of muscle dysfunction in COPD. J Appl Physiol (1985), 2013, 114(9): 1222-1234.
3.	Duiverman ML, Wempe JB, Bladder G, et al. Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients: a randomized controlled trial. Respir Res, 2011, 12: 112.
4.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5. 1. 0).[Cited 2012 Jan 5]. Available at: http://www.cochrane-handbook.org..
5.	林國勇. 長期無創正壓通氣在穩定期慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭中的應用價值. 現代診斷與治療, 2015, 10(20): 4752-4754.
6.	李元廣, 徐效峰, 趙宇, 等. 夜間無創通氣應用于穩定期慢性阻塞性肺疾病患者的臨床觀察. 山西醫藥雜志, 2015, 44(17): 1993-1994.
7.	徐月清, 王曉玲, 方紅偉, 等. 家庭無創通氣治療慢性阻塞性肺疾病穩定期合并慢性Ⅱ型呼吸衰竭患者療效分析. 農墾醫學, 2015, 37(2): 133-135.
8.	張志大, 張愛妹, 吳海燕, 等. 長期家庭無創正壓通氣治療穩定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的臨床效果研究. 實用心腦肺血管病雜志, 2013, 21(12): 8-10.
9.	周世新, 肖學平, 譚金. 無創正壓通氣在穩定期 COPD 并慢性呼衰患者中的應用效果觀察. 海南醫學, 2012, 23(14): 33-35.
10.	李雪華, 李報春, 張宇飛, 等. 慢性阻塞性肺疾病患者長期家庭無創正壓通氣療效觀察. 老年醫學與保健, 2012, 18(6): 376-378.
11.	鄭曉璐, 李明生, 魏厚華. 家庭雙水平無創正壓機械通氣對穩定期極重度 COPD 患者的療效觀察. 中國醫藥導報, 2012, 9(1): 132-134.
12.	范敏娟, 趙國厚, 沈雯. 長期家庭無創正壓通氣治療重度慢性阻塞性肺疾病穩定期的療效觀察. 醫學信息, 2011, 24(4): 1255-1256.
13.	唐猛, 朱君飛, 陳曉, 等. 家庭無創通氣并家庭氧療治療慢性阻塞性肺疾病穩定期并Ⅱ型呼吸衰竭療效分析. 中國醫師進修雜志, 2010, 33(22): 39-41.
14.	尚玉龍, 羅為, 陸娟. 無創正壓機械通氣對重度慢性阻塞性肺疾病穩定期患者的治療作用. 臨床肺科雜志, 2009, 14(9): 1151-1152.
15.	李戰成, 張清君, 張祥杰, 等. 重度慢性阻塞性肺病穩定期實施家庭無創正壓通氣的臨床價值. 中國現代藥物應用, 2009, 3(14): 51-53.
16.	歐陽修河, 胡翠花, 李玉, 等. 嚴重 COPD 患者穩定期長期無創正壓通氣治療臨床療效及依從性觀察. 醫學研究雜志, 2009, 38(4): 69-72.
17.	周曉輝, 楊敬業, 沈策. 慢性阻塞性肺病緩解期患者家庭氧療及無創通氣的療效. 中國臨床醫學, 2008, 15(4): 486-488.
18.	向平超, 張鑫, 楊琚, 等. 家庭無創正壓機械通氣對穩定期重度慢性阻塞性肺疾病患者的療效和安全性觀察. 中華結核和呼吸雜志, 2007, 30(10): 746-750.
19.	Kolodziej MA, Jensen L, Rowe B, et al. Systematic review of noninvasive positive pressure ventilation in severe stable COPD. Eur Respir J, 2007, 30(2): 293-306.
20.	Struik FM, Lacasse Y, Goldstein R, et al. Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2013, 13(6): CD002878.
21.	Struik FM, Lacasse Y, Goldstein RS, et al. Nocturnal noninvasive positive pressure ventilation in stable COPD: a systematic review and individual patient data meta-analysis. Respir Med, 2014, 108(2): 329-337.
22.	Wijkstra PJ, Lacasse Y, Guyatt GH, et al. A meta-analysis of nocturnal noninvasive positive pressure ventilation in patients with stable COPD. Chest, 2003, 124(1): 337-343.
23.	劉曄, 代冰, 蘇佳, 等. 重度慢阻肺穩定期患者應用家庭無創通氣療效的薈萃分析. 中華結核和呼吸雜志, 2017, 40(5): 354-362.
24.	孟珊珊, 閆冰迪, 辛秀琴, 等. 家庭無創正壓通氣對我國慢性阻塞性肺疾病穩定期患者療效的meta分析. 中國實驗診斷學, 2017, 21(1): 149-151.
25.	Simonds AK. Home ventilation. Eur Respir J, 2003, 22(47 suppl): 38s-46s.
26.	Lloyd-Owen SJ, Donaldson GC, Ambrosino N, et al. Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey. Eur Respir J, 2005, 25(6): 1025-1031.
27.	K?hnlein T, Windisch W, K?hler D, et al. Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. Lancet Respir Med, 2014, 2(9): 698-705.
28.	Struik FM, Sprooten RT, Kerstjens HA, et al. Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure: a randomised, controlled, parallel-group study. Thorax, 2014, 69(9): 826-834.
29.	沈寧, 姚婉貞, 朱紅. 北京市延慶縣慢性阻塞性肺疾病患者的認知情況調查. 中華結核和呼吸雜志, 2008, 31(3): 206-208.
30.	中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病的中國夢. 中華結核和呼吸雜志, 2013, 36(12): 902-906.
31.	慢性阻塞性肺疾病評估論壇專家組. 慢性阻塞性肺疾病病情嚴重程度評估系統在中國應用的專家共識. 中華結核和呼吸雜志, 2013, 36(6): 476-478.
32.	中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南(2013 年修訂版). 中華結核和呼吸雜志, 2013, 36(4): 255-264.
33.	陳亞紅, 姚婉貞, 康健, 等. 慢性阻塞性肺疾病患者治療狀況與自我認知的多中心調查研究. 中華結核和呼吸雜志, 2010, 33(10): 750-753.
34.	Simonds AK. Long-term ventilation in obstructive ventilatory disorders. Respir Care Clin N Am, 2002, 8(4): 533-544.
35.	Foucher P, Baudouin N, Merati M, et al. Relative survival analysis of 252 patients with COPD receiving long-term oxygen therapy. Chest, 1998, 113(6): 1580-1587.

1. GOLD Executive Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (Updated 2018). Available at: http://goldcopd.org/..
2. Gea J, Agustí A, Roca J. Pathophysiology of muscle dysfunction in COPD. J Appl Physiol (1985), 2013, 114(9): 1222-1234.
3. Duiverman ML, Wempe JB, Bladder G, et al. Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients: a randomized controlled trial. Respir Res, 2011, 12: 112.
4. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5. 1. 0).[Cited 2012 Jan 5]. Available at: http://www.cochrane-handbook.org..
5. 林國勇. 長期無創正壓通氣在穩定期慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭中的應用價值. 現代診斷與治療, 2015, 10(20): 4752-4754.
6. 李元廣, 徐效峰, 趙宇, 等. 夜間無創通氣應用于穩定期慢性阻塞性肺疾病患者的臨床觀察. 山西醫藥雜志, 2015, 44(17): 1993-1994.
7. 徐月清, 王曉玲, 方紅偉, 等. 家庭無創通氣治療慢性阻塞性肺疾病穩定期合并慢性Ⅱ型呼吸衰竭患者療效分析. 農墾醫學, 2015, 37(2): 133-135.
8. 張志大, 張愛妹, 吳海燕, 等. 長期家庭無創正壓通氣治療穩定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的臨床效果研究. 實用心腦肺血管病雜志, 2013, 21(12): 8-10.
9. 周世新, 肖學平, 譚金. 無創正壓通氣在穩定期 COPD 并慢性呼衰患者中的應用效果觀察. 海南醫學, 2012, 23(14): 33-35.
10. 李雪華, 李報春, 張宇飛, 等. 慢性阻塞性肺疾病患者長期家庭無創正壓通氣療效觀察. 老年醫學與保健, 2012, 18(6): 376-378.
11. 鄭曉璐, 李明生, 魏厚華. 家庭雙水平無創正壓機械通氣對穩定期極重度 COPD 患者的療效觀察. 中國醫藥導報, 2012, 9(1): 132-134.
12. 范敏娟, 趙國厚, 沈雯. 長期家庭無創正壓通氣治療重度慢性阻塞性肺疾病穩定期的療效觀察. 醫學信息, 2011, 24(4): 1255-1256.
13. 唐猛, 朱君飛, 陳曉, 等. 家庭無創通氣并家庭氧療治療慢性阻塞性肺疾病穩定期并Ⅱ型呼吸衰竭療效分析. 中國醫師進修雜志, 2010, 33(22): 39-41.
14. 尚玉龍, 羅為, 陸娟. 無創正壓機械通氣對重度慢性阻塞性肺疾病穩定期患者的治療作用. 臨床肺科雜志, 2009, 14(9): 1151-1152.
15. 李戰成, 張清君, 張祥杰, 等. 重度慢性阻塞性肺病穩定期實施家庭無創正壓通氣的臨床價值. 中國現代藥物應用, 2009, 3(14): 51-53.
16. 歐陽修河, 胡翠花, 李玉, 等. 嚴重 COPD 患者穩定期長期無創正壓通氣治療臨床療效及依從性觀察. 醫學研究雜志, 2009, 38(4): 69-72.
17. 周曉輝, 楊敬業, 沈策. 慢性阻塞性肺病緩解期患者家庭氧療及無創通氣的療效. 中國臨床醫學, 2008, 15(4): 486-488.
18. 向平超, 張鑫, 楊琚, 等. 家庭無創正壓機械通氣對穩定期重度慢性阻塞性肺疾病患者的療效和安全性觀察. 中華結核和呼吸雜志, 2007, 30(10): 746-750.
19. Kolodziej MA, Jensen L, Rowe B, et al. Systematic review of noninvasive positive pressure ventilation in severe stable COPD. Eur Respir J, 2007, 30(2): 293-306.
20. Struik FM, Lacasse Y, Goldstein R, et al. Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2013, 13(6): CD002878.
21. Struik FM, Lacasse Y, Goldstein RS, et al. Nocturnal noninvasive positive pressure ventilation in stable COPD: a systematic review and individual patient data meta-analysis. Respir Med, 2014, 108(2): 329-337.
22. Wijkstra PJ, Lacasse Y, Guyatt GH, et al. A meta-analysis of nocturnal noninvasive positive pressure ventilation in patients with stable COPD. Chest, 2003, 124(1): 337-343.
23. 劉曄, 代冰, 蘇佳, 等. 重度慢阻肺穩定期患者應用家庭無創通氣療效的薈萃分析. 中華結核和呼吸雜志, 2017, 40(5): 354-362.
24. 孟珊珊, 閆冰迪, 辛秀琴, 等. 家庭無創正壓通氣對我國慢性阻塞性肺疾病穩定期患者療效的meta分析. 中國實驗診斷學, 2017, 21(1): 149-151.
25. Simonds AK. Home ventilation. Eur Respir J, 2003, 22(47 suppl): 38s-46s.
26. Lloyd-Owen SJ, Donaldson GC, Ambrosino N, et al. Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey. Eur Respir J, 2005, 25(6): 1025-1031.
27. K?hnlein T, Windisch W, K?hler D, et al. Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. Lancet Respir Med, 2014, 2(9): 698-705.
28. Struik FM, Sprooten RT, Kerstjens HA, et al. Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure: a randomised, controlled, parallel-group study. Thorax, 2014, 69(9): 826-834.
29. 沈寧, 姚婉貞, 朱紅. 北京市延慶縣慢性阻塞性肺疾病患者的認知情況調查. 中華結核和呼吸雜志, 2008, 31(3): 206-208.
30. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病的中國夢. 中華結核和呼吸雜志, 2013, 36(12): 902-906.
31. 慢性阻塞性肺疾病評估論壇專家組. 慢性阻塞性肺疾病病情嚴重程度評估系統在中國應用的專家共識. 中華結核和呼吸雜志, 2013, 36(6): 476-478.
32. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南(2013 年修訂版). 中華結核和呼吸雜志, 2013, 36(4): 255-264.
33. 陳亞紅, 姚婉貞, 康健, 等. 慢性阻塞性肺疾病患者治療狀況與自我認知的多中心調查研究. 中華結核和呼吸雜志, 2010, 33(10): 750-753.
34. Simonds AK. Long-term ventilation in obstructive ventilatory disorders. Respir Care Clin N Am, 2002, 8(4): 533-544.
35. Foucher P, Baudouin N, Merati M, et al. Relative survival analysis of 252 patients with COPD receiving long-term oxygen therapy. Chest, 1998, 113(6): 1580-1587.

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