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.	林国勇. 长期无创正压通气在稳定期慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭中的应用价值. 现代诊断与治疗, 2015, 10(20): 4752-4754.
6.	李元广, 徐效峰, 赵宇, 等. 夜间无创通气应用于稳定期慢性阻塞性肺疾病患者的临床观察. 山西医药杂志, 2015, 44(17): 1993-1994.
7.	徐月清, 王晓玲, 方红伟, 等. 家庭无创通气治疗慢性阻塞性肺疾病稳定期合并慢性Ⅱ型呼吸衰竭患者疗效分析. 农垦医学, 2015, 37(2): 133-135.
8.	张志大, 张爱妹, 吴海燕, 等. 长期家庭无创正压通气治疗稳定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床效果研究. 实用心脑肺血管病杂志, 2013, 21(12): 8-10.
9.	周世新, 肖学平, 谭金. 无创正压通气在稳定期 COPD 并慢性呼衰患者中的应用效果观察. 海南医学, 2012, 23(14): 33-35.
10.	李雪华, 李报春, 张宇飞, 等. 慢性阻塞性肺疾病患者长期家庭无创正压通气疗效观察. 老年医学与保健, 2012, 18(6): 376-378.
11.	郑晓璐, 李明生, 魏厚华. 家庭双水平无创正压机械通气对稳定期极重度 COPD 患者的疗效观察. 中国医药导报, 2012, 9(1): 132-134.
12.	范敏娟, 赵国厚, 沈雯. 长期家庭无创正压通气治疗重度慢性阻塞性肺疾病稳定期的疗效观察. 医学信息, 2011, 24(4): 1255-1256.
13.	唐猛, 朱君飞, 陈晓, 等. 家庭无创通气并家庭氧疗治疗慢性阻塞性肺疾病稳定期并Ⅱ型呼吸衰竭疗效分析. 中国医师进修杂志, 2010, 33(22): 39-41.
14.	尚玉龙, 罗为, 陆娟. 无创正压机械通气对重度慢性阻塞性肺疾病稳定期患者的治疗作用. 临床肺科杂志, 2009, 14(9): 1151-1152.
15.	李战成, 张清君, 张祥杰, 等. 重度慢性阻塞性肺病稳定期实施家庭无创正压通气的临床价值. 中国现代药物应用, 2009, 3(14): 51-53.
16.	欧阳修河, 胡翠花, 李玉, 等. 严重 COPD 患者稳定期长期无创正压通气治疗临床疗效及依从性观察. 医学研究杂志, 2009, 38(4): 69-72.
17.	周晓辉, 杨敬业, 沈策. 慢性阻塞性肺病缓解期患者家庭氧疗及无创通气的疗效. 中国临床医学, 2008, 15(4): 486-488.
18.	向平超, 张鑫, 杨琚, 等. 家庭无创正压机械通气对稳定期重度慢性阻塞性肺疾病患者的疗效和安全性观察. 中华结核和呼吸杂志, 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.	刘晔, 代冰, 苏佳, 等. 重度慢阻肺稳定期患者应用家庭无创通气疗效的荟萃分析. 中华结核和呼吸杂志, 2017, 40(5): 354-362.
24.	孟珊珊, 闫冰迪, 辛秀琴, 等. 家庭无创正压通气对我国慢性阻塞性肺疾病稳定期患者疗效的meta分析. 中国实验诊断学, 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.	Köhnlein T, Windisch W, Köhler 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.	沈宁, 姚婉贞, 朱红. 北京市延庆县慢性阻塞性肺疾病患者的认知情况调查. 中华结核和呼吸杂志, 2008, 31(3): 206-208.
30.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病的中国梦. 中华结核和呼吸杂志, 2013, 36(12): 902-906.
31.	慢性阻塞性肺疾病评估论坛专家组. 慢性阻塞性肺疾病病情严重程度评估系统在中国应用的专家共识. 中华结核和呼吸杂志, 2013, 36(6): 476-478.
32.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013 年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
33.	陈亚红, 姚婉贞, 康健, 等. 慢性阻塞性肺疾病患者治疗状况与自我认知的多中心调查研究. 中华结核和呼吸杂志, 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. 林国勇. 长期无创正压通气在稳定期慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭中的应用价值. 现代诊断与治疗, 2015, 10(20): 4752-4754.
6. 李元广, 徐效峰, 赵宇, 等. 夜间无创通气应用于稳定期慢性阻塞性肺疾病患者的临床观察. 山西医药杂志, 2015, 44(17): 1993-1994.
7. 徐月清, 王晓玲, 方红伟, 等. 家庭无创通气治疗慢性阻塞性肺疾病稳定期合并慢性Ⅱ型呼吸衰竭患者疗效分析. 农垦医学, 2015, 37(2): 133-135.
8. 张志大, 张爱妹, 吴海燕, 等. 长期家庭无创正压通气治疗稳定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床效果研究. 实用心脑肺血管病杂志, 2013, 21(12): 8-10.
9. 周世新, 肖学平, 谭金. 无创正压通气在稳定期 COPD 并慢性呼衰患者中的应用效果观察. 海南医学, 2012, 23(14): 33-35.
10. 李雪华, 李报春, 张宇飞, 等. 慢性阻塞性肺疾病患者长期家庭无创正压通气疗效观察. 老年医学与保健, 2012, 18(6): 376-378.
11. 郑晓璐, 李明生, 魏厚华. 家庭双水平无创正压机械通气对稳定期极重度 COPD 患者的疗效观察. 中国医药导报, 2012, 9(1): 132-134.
12. 范敏娟, 赵国厚, 沈雯. 长期家庭无创正压通气治疗重度慢性阻塞性肺疾病稳定期的疗效观察. 医学信息, 2011, 24(4): 1255-1256.
13. 唐猛, 朱君飞, 陈晓, 等. 家庭无创通气并家庭氧疗治疗慢性阻塞性肺疾病稳定期并Ⅱ型呼吸衰竭疗效分析. 中国医师进修杂志, 2010, 33(22): 39-41.
14. 尚玉龙, 罗为, 陆娟. 无创正压机械通气对重度慢性阻塞性肺疾病稳定期患者的治疗作用. 临床肺科杂志, 2009, 14(9): 1151-1152.
15. 李战成, 张清君, 张祥杰, 等. 重度慢性阻塞性肺病稳定期实施家庭无创正压通气的临床价值. 中国现代药物应用, 2009, 3(14): 51-53.
16. 欧阳修河, 胡翠花, 李玉, 等. 严重 COPD 患者稳定期长期无创正压通气治疗临床疗效及依从性观察. 医学研究杂志, 2009, 38(4): 69-72.
17. 周晓辉, 杨敬业, 沈策. 慢性阻塞性肺病缓解期患者家庭氧疗及无创通气的疗效. 中国临床医学, 2008, 15(4): 486-488.
18. 向平超, 张鑫, 杨琚, 等. 家庭无创正压机械通气对稳定期重度慢性阻塞性肺疾病患者的疗效和安全性观察. 中华结核和呼吸杂志, 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. 刘晔, 代冰, 苏佳, 等. 重度慢阻肺稳定期患者应用家庭无创通气疗效的荟萃分析. 中华结核和呼吸杂志, 2017, 40(5): 354-362.
24. 孟珊珊, 闫冰迪, 辛秀琴, 等. 家庭无创正压通气对我国慢性阻塞性肺疾病稳定期患者疗效的meta分析. 中国实验诊断学, 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. Köhnlein T, Windisch W, Köhler 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. 沈宁, 姚婉贞, 朱红. 北京市延庆县慢性阻塞性肺疾病患者的认知情况调查. 中华结核和呼吸杂志, 2008, 31(3): 206-208.
30. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病的中国梦. 中华结核和呼吸杂志, 2013, 36(12): 902-906.
31. 慢性阻塞性肺疾病评估论坛专家组. 慢性阻塞性肺疾病病情严重程度评估系统在中国应用的专家共识. 中华结核和呼吸杂志, 2013, 36(6): 476-478.
32. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013 年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
33. 陈亚红, 姚婉贞, 康健, 等. 慢性阻塞性肺疾病患者治疗状况与自我认知的多中心调查研究. 中华结核和呼吸杂志, 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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