背景：无创通气（NIV）是慢性高碳酸血症性呼吸衰竭COPD患者的推荐治疗方法。早上摘除口罩后，呼吸困难持续，通常被称为断肠综合征，是一种常见的副作用，但尚未得到很好的表征。本研究旨在探讨其发病机理，确定断管综合征的危险因素和可能的治疗策略。
方法：前瞻性，控制,进行了非盲化研究.经过一夜的NIV治疗，病人接受了肺活量测定,直接进行血气分析和6分钟步行测试（6MWT），在去除掩模后2和4小时。通过改良的Borg量表测量呼吸困难。使用身体体积描记术和健康相关生活质量（HRQoL）问卷。在研究的第二个晚上，对患有断气综合征（定义为摘除面罩后Borg量表上至少有三个点的呼吸困难）的患者进行了非侵入性唇下呼吸通气（PLBV）治疗。
结果：纳入的31例患者中有11例（35%）符合给定的断肠综合征标准。与2小时后的测量结果（4.8±2.6；p=0.003）相比，他们在摘除面罩后直接在Borg量表上报告的呼吸困难明显更多（平均值：7.2±1.0）。最初，与2小时后（54±15％；p=0.002）相比，平均吸气肺活量显着降低（VCmax：46±16％），而没有观察到脉搏血氧饱和度或血气分析的变化。患有断肠综合征的患者的平均气道阻力（Reff：320±88.5％）明显高于对照组（253±147％；p=0.021）。他们在严重呼吸功能不全问卷中的得分也显着降低（SRI；平均值：37.6±10.1vs50.6±16.7，p=0.027）。在PLBV模式下通风一晚后，与已确定治疗后的7.2±1.0相比，平均早晨呼吸困难显着降低至5.6±2.0（p=0.019），平均吸气肺活量从44±16.0％增加至48±16.3（p=0.040）。
结论：断气综合征是COPD患者NIV的严重副作用，以增加呼吸困难为特征。它与肺活量下降有关，去除面罩后的运动耐量和较低的HRQoL。气道阻力高的患者患早晨呼吸困难的风险更大。PLBV模式下的通气可以预防或改善断肠综合征。
背景：该研究于2019年4月9日在德国临床试验注册（DRKS00016941）中注册。
BACKGROUND: Non-invasive ventilation (NIV) is a recommended treatment for COPD patients suffering from chronic hypercapnic respiratory failure. Prolonged dyspnea after mask removal in the morning, often referred to as deventilation syndrome, is a common side effect but has been poorly characterized yet. This
study aimed to explore the pathomechanism, identify risk factors and possible treatment strategies for the deventilation syndrome.
METHODS: A prospective, controlled, non-blinded
study was conducted. After a night with established NIV therapy, the patients underwent spirometry, blood gas analyses and 6-min walking tests (6MWT) directly, at 2 and 4 h after mask removal. Dyspnea was measured by the modified Borg scale. Bodyplethysmography and health-related quality of life (HRQoL) questionnaires were used. Patients suffering from deventilation syndrome (defined as dyspnea of at least three points on the Borg scale after mask removal) were treated with non-invasive pursed lip breathing ventilation (PLBV) during the second night of the
study.
RESULTS: Eleven of 31 patients included (35%) met the given criteria for a deventilation syndrome. They reported significantly more dyspnea on the Borg scale directly after mask removal (mean: 7.2 ± 1.0) compared to measurement after 2 h (4.8 ± 2.6; p = 0.003). Initially, mean inspiratory vital capacity was significantly reduced (VCmax: 46 ± 16%) compared to 2 h later (54 ± 15%; p = 0.002), while no changes in pulse oximetry or blood gas analysis were observed. Patients who suffered from a deventilation syndrome had a significantly higher mean airway resistance (Reff: 320 ± 88.5%) than the patients in the control group (253 ± 147%; p = 0.021). They also scored significantly lower on the Severe Respiratory Insufficiency Questionnaire (SRI; mean: 37.6 ± 10.1 vs 50.6 ± 16.7, p = 0.027). After one night of ventilation in PLBV mode, mean morning dyspnea decreased significantly to 5.6 ± 2.0 compared to 7.2 ± 1.0 after established treatment (p = 0.019) and mean inspiratory vital capacity increased from 44 ± 16.0% to 48 ± 16.3 (p = 0.040).
CONCLUSIONS: The deventilation syndrome is a serious side effect of NIV in COPD patients, characterized by increase of dyspnea. It is associated with decrease in vital capacity, exercise tolerance after mask removal and lower HRQoL. Patients with high airway resistance are at greater risk of suffering from morning dyspnea. Ventilation in PLBV mode may prevent or improve the deventilation syndrome.
BACKGROUND: The
study was registered in the German Clinical Trials Register (DRKS00016941) on 09 April 2019.
