晚期慢性阻塞性肺疾病患者稳定期长期无创正压通气的依从性调查  

Evaluation of the compliance for the long-term noninvasive positive pressure ventilation in patients with stable advanced chronic obstructive pulmonary disease

作　　者：韩其政[1] 亓梅[1] 冯倩 贾曰林[1] 李珍[1] Han Qizheng;Qi Mei;Feng Qzan;Jia Yuelin;Li Zhen(Department of Respiratory Medicine,Shandong University Affiliated Provincial Hospital (West Hospital),Jinan 250022,China)

机构地区：[1]山东大学附属省立医院(西院)呼吸科,济南250022

出　　处：《国际呼吸杂志》2019年第2期81-85,共5页International Journal of Respiration

基　　金：济南市科技计划项目(201302164).

摘　　要：目的调查分析稳定期慢性阻塞性肺疾病(COPD)患者对无创正压通气(NPPV)治疗的依从性。方法对107例符合应用NPPV标准的患者推荐使用无创呼吸机进行长期家庭无创通气治疗。经健康教育及反复推荐或试用,患者及家属接受并购买家用无创呼吸机在医师指导下进行NPPV者为依从性好,经反复推荐或试用,最后患者和家属未接受和采用NPPV治疗者为依从性差,对不接受NPPV治疗的原因进行归类,归类原因包括家庭收入、文化程度、年龄、家属协同教育、认知性、生理性、心因性等,并统计各类原因所占比例。对稳定期COPD患者使用NPPV的依从性行Cox回归分析,探讨提高依从性的因素。结果(1)107例患者中,24例(22.40%)购买了无创呼吸机并在医师的指导下进行了无创通气治疗。(2)未接受NPPV治疗的患者原因占比分别为:家庭收入低55.90%(52/83),文化程度低76.34%(71/83),家属不配合60.20%(56/83),高龄82.80%(77/83),认知性28.00%(26/83),生理性7.50%(7/83),心因性4.30%(4/83);(3)对稳定期COPD患者使用NPPV的依从性行Cox回归分析,显示年龄<70岁(HR=2.667,95%CI:0.132~3.370)、文化程度高(HR=1.949,95%CI:0.232~3.884)、家庭收入高(HR=2.427,95%CI:0.045~4.020)、家属协同教育(HR=2.545,95%CI:1.262~5.133)是提高患者无创呼吸机使用依从性的因素(P<0.05)。结论稳定期COPD患者对于NPPV的依从性差,年龄、文化程度、家庭收入、家属协同教育是影响患者依从性的因素。Objective To investe the compliance that the patients who have stable chronic obstructive pulmonary disease (COPD) with hypercapnia didn′t use the long-term noninvasive positive pressure ventilation (NPPV).Methods One hundred and seven patients who met the NPPV criteria were advised to do the long-term noninvasive ventilation with non-invasive ventilators.After health education and repeated recommendation or trial, patients and their families accepted, purchased home non-invasive ventilator and did the NPPV under the guidance of a doctor were good compliance;inversely, the patients and their families did not accept and use NPPV treatment were bad compliance.Categorized the causes of bad compliance, including family income, education level, age and family members′ collaborative education, cognitive, physiological, physiologic and so on.Cox regression analysis was used to assess compliance with NPPV in patients with stable COPD and to explore factors that increased compliance.Results (1)Of the one hundred and seven patients, twenty-four (22.40%) had purchased a noninvasive ventilator and underwent NPPV under the guidance of a physician.(2) Of the patients who did not receive NPPV treatment, low household income accounted for 55.90%(52/83), education was low at 76.34%(71/83), family members did not cooperate at 60.20%(56/83), senior citizens accounted for 82.80%(77/83), cognition at 28.00%(26/83), physiology at 7.50%(7/83), and psychogenic at 4.30%(4/83). (3)Cox regression analysis of NPPV compliance in patients with stable COPD, COX regression analysis showed age <70 years (HR=2.667, 95%CI: 0.132-3.370), high education (HR=1.949, 95%CI: 0.232-3.884), high household income (HR=2.427, 95%CI: 0.045-4.020), family cooperative education (HR=2.545, 95%CI: 1.262-5.133) were factors that increase patient compliance with non-invasive ventilators (P<0.05).Conclusions COPD patients have poor compliance with NPPV.Age, education level, family income, and family cooperative education are factors that affect the patient′s c

关 键 词：肺疾病 慢性阻塞性 无创正压通气 依从性 

分 类 号：R563.9[医药卫生—呼吸系统]