重度の慢性閉塞性肺疾患における負圧換気による効果
S H Shapiro1, P Ernst, K Gray-Donald
1Department of Epidemiology, McGill University, Montreal, Quebec, Canada.
Lancet (London, England)
|December 12, 1992
まとめ
負圧換気 (NPV) は,慢性閉塞性肺疾患 (COPD) の患者のアウトカムを改善しませんでした. この研究では,NPVは静止している呼吸器の筋肉に効果がなく,患者によって受け入れられていないことが判明しました.
科学分野:
- 呼吸器医学とは
- 肺のリハビリテーション
- クリニック・トライアル 臨床試験
背景:
- 慢性阻害性肺疾患 (COPD) は,しばしば鼓動筋疲労と関連しています.
- 刺激的な筋肉の休息は,COPD患者の潜在的な治療戦略です.
研究 の 目的:
- 陰圧換気 (NPV) による呼吸筋の休息が重症のCOPD患者の治療結果を改善するという仮説を検証する.
- 安定したCOPDにおけるNPVの有効性と患者の受容性を評価する.
主な方法:
- 重度のCOPD患者184人を対象とした12週間の,ダブルブラインド,ランダム化制御試験.
- 患者は自宅でアクティブまたは偽のNPV治療を受けた.
- プライマリアウトカム:6分ウォーキングテスト距離. 二次的なアウトカム:運動耐久性,呼吸不全,生活の質,血液ガス,呼吸器の筋肉の強さ.
主要な成果:
- 6分のウォーキングテスト,運動耐久性,呼吸不全,生活の質,血液ガス,または呼吸器の筋肉の強さにおいて,アクティブグループと偽のNPVグループ間の有意な違いは観察されなかった.
- NPVの使用と患者のアウトカムとの間には,投与量-反応関係が見つかりませんでした.
- 臨床的サポートにもかかわらず,NPV介入に対する患者の受け入れは低かった.
結論:
- この研究で適用された負圧換気は,実装が困難であり,安定したCOPD患者の静止呼吸器の筋肉に効果を示さなかった.
- この結果から,NPVは,この患者集団におけるアウトカムを改善するための適切な介入ではないことを示唆しています.
- COPDにおけるインスピレーション筋の休息のための代替方法を模索するために,さらなる研究が必要になる可能性があります.
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