{"id":2147,"date":"2021-06-09T11:46:38","date_gmt":"2021-06-09T02:46:38","guid":{"rendered":"https:\/\/www.hcfm.jp\/journal\/?p=2147"},"modified":"2021-06-09T11:46:38","modified_gmt":"2021-06-09T02:46:38","slug":"copd%e6%82%a3%e8%80%85%e3%81%a8%e5%9c%a8%e5%ae%85nppv","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=2147","title":{"rendered":"COPD\u60a3\u8005\u3068\u5728\u5b85NPPV"},"content":{"rendered":"

\u2015\u6587\u732e\u540d\u2015
\nWilson ME, et al. Association of Home Noninvasive Positive Pressure Ventilation With Clinical Outcomes in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis. JAMA. 2020 Feb 4;323(5):455-465.<\/p>\n

\u2015\u8981\u7d04\u2015
\nIntroduction<\/strong>
\nCOPD\u60a3\u8005\u306e\u6025\u6027\u5897\u60aa\u6642\u306b\u304a\u3051\u308b\u9ad8CO2\u8840\u75c7\u30fb\u6025\u6027\u547c\u5438\u4e0d\u5168\u306b\u5bfe\u3057\u3066\u306eNIPPV\u306e\u9662\u5185\u4f7f\u7528\u306b\u3064\u3044\u3066\u306f\u30a8\u30d3\u30c7\u30f3\u30b9\u304c\u78ba\u7acb\u3057\u3066\u3044\u308b\uff08COPD\u6025\u6027\u5897\u60aa\u306b\u3088\u308b\u6025\u6027\u547c\u5438\u4e0d\u5168\u306e\u60a3\u8005\u306b\u304a\u3044\u3066\u3001\u9662\u5185NIPPV\u306f\u3001\u6b7b\u4ea1\u7387\u306e\u4f4e\u4e0b\u3001\u6c17\u7ba1\u633f\u7ba1\u306e\u6e1b\u5c11\u3001\u5165\u9662\u671f\u9593\u306e\u77ed\u7e2e\u3001\u5408\u4f75\u75c7\u306e\u6e1b\u5c11\u306b\u95a2\u9023\u3057\u3066\u3044\u308b\u3053\u3068\u304c\u308f\u304b\u3063\u3066\u3044\u308b\u3002\uff09\u3057\u304b\u3057\u3001\u6162\u6027COPD\u3068\u9ad8CO2\u8840\u75c7<\/span>\u306b\u304a\u3051\u308b\u5728\u5b85NIPPV<\/span>\u3068\u305d\u306e\u8ee2\u5e30\u3068\u306e\u95a2\u9023\u306f\u4e0d\u660e\u3067\u3042\u308b\u3002
\nCOPD \u304a\u3088\u3073\u9ad8CO2\u8840\u75c7\u306e\u60a3\u8005\u306b\u304a\u3044\u3066\u3001bilevel positive airway pressure \uff08BPAP\uff09\u304a\u3088\u3073noninvasive home mechanical ventilator \uff08\u975e\u4fb5\u8972\u7684HMV\uff09\u306b\u3088\u308b\u5728\u5b85 NIPPV \u3068\u81e8\u5e8a\u8ee2\u5e30\u304a\u3088\u3073\u6709\u5bb3\u4e8b\u8c61\u3068\u306e\u95a2\u9023\u3092\u8a55\u4fa1\u3057\u305f\u3002<\/p>\n

\u203b\u547c\u5438\u6a5f\u5668\u306e\u5b9a\u7fa9\u306b\u95a2\u3057\u3066\u306f\u3001eTable2\u53c2\u7167
\nBPAP\u88c5\u7f6e\u306f\u901a\u5e38\u3001\u5727\u63db\u6c17\u3092\u884c\u3046\u304c\u3001\u63db\u6c17\u30e2\u30fc\u30c9\u3084\u30e2\u30cb\u30bf\u30ea\u30f3\u30b0\u6a5f\u80fd\u304c\u8ffd\u52a0\u3055\u308c\u3066\u3044\u308b\u5834\u5408\u304c\u3042\u308b\u3002HMV\u306f\u3001Pressure control\u63db\u6c17\u3001Volume control\u63db\u6c17\u306a\u3069\u304c\u53ef\u80fd\u3067\u3042\u308a\u3001\u901a\u5e38\u306f\u6c17\u7ba1\u5207\u958b\u3057\u305f\u60a3\u8005\u306b\u4f7f\u7528\u3055\u308c\u308b\u304c\u3001NIPPV\u3067\u3082\u4f7f\u7528\u3067\u304d\u308b\u3002BPAP\u88c5\u7f6e\u3068\u6bd4\u8f03\u3057\u3066\u3001\u8ffd\u52a0\u306e\u63db\u6c17\u30e2\u30fc\u30c9\u3001\u30e2\u30cb\u30bf\u30ea\u30f3\u30b0\u3001\u5236\u5fa1\u6a5f\u80fd\u3001\u304a\u3088\u3073\u5b89\u5168\u88c5\u7f6e\u3001\u30a2\u30e9\u30fc\u30e0\u3001\u30d0\u30c3\u30af\u30a2\u30c3\u30d7\u96fb\u6e90\u306e\u6a5f\u80fd\u3092\u5099\u3048\u3066\u3044\u308b\u3002<\/p>\n

Method<\/strong>
\n1995\u5e741\u67081\u65e5\u304b\u30892019\u5e7411\u67086\u65e5\u307e\u3067\u306b\u767a\u8868\u3055\u308c\u305f\u82f1\u8a9e\u306e\u8ad6\u6587\u3092MEDLINE\u3001EMBASE\u3001SCOPUS\u3001Cochrane Central Registrar of Controlled Trials\u3001Cochrane Database of Systematic Reviews\u3001National Guideline Clearinghouse\u3001Scopus\u3067\u691c\u7d22\u3057\u305f\u3002
\n\u5728\u5b85NIPPV\u30921\u304b\u6708\u4ee5\u4e0a\u4f7f\u7528\u3057\u305f\u9ad8CO2\u8840\u75c7\u3092\u4f34\u3046COPD\u306e\u6210\u4eba\u3092\u767b\u9332\u3057\u305f\u7121\u4f5c\u70ba\u5316\u81e8\u5e8a\u8a66\u9a13\uff08RCT\uff09\u304a\u3088\u3073\u6bd4\u8f03\u89b3\u5bdf\u7814\u7a76\u3092\u5bfe\u8c61\u3068\u3057\u305f\u3002
\n\u30c7\u30fc\u30bf\u306e\u62bd\u51fa\u306f\u72ec\u7acb\u3057\u305f 2 \u4eba\u306e\u30ec\u30d3\u30e5\u30a2\u30fc\u304c\u884c\u3063\u305f\u3002\u30d0\u30a4\u30a2\u30b9\u306b\u3064\u3044\u3066\u306fRCT \u306b\u3064\u3044\u3066\u306f Cochrane Collaboration \u306e risk of bias tool \u3092\u7528\u3044\u3066\u8a55\u4fa1\u3057\u3001\u975e\u30e9\u30f3\u30c0\u30e0\u5316\u7814\u7a76\u306b\u3064\u3044\u3066\u306f Newcastle-Ottawa Scale \u306e\u9078\u629e\u9805\u76ee\u3092\u7528\u3044\u3066\u8a55\u4fa1\u3057\u305f\u3002
\n\u4e3b\u8981\u8a55\u4fa1\u9805\u76ee\u306f\u3001\u6700\u9577\u8ffd\u8de1\u671f\u9593\u306b\u304a\u3051\u308b\u6b7b\u4ea1\u7387\u3001\u5168\u539f\u56e0\u306b\u3088\u308b\u5165\u9662\u3001\u633f\u7ba1\u306e\u5fc5\u8981\u6027\u3001\u304a\u3088\u3073 QOL \u3068\u3057\u305f\u3002\u526f\u6b21\u8a55\u4fa1\u9805\u76ee\u306f\u3001\u547c\u5438\u5668\u75be\u60a3\u306b\u3088\u308b\u5165\u9662\u3001\u6551\u6025\u5916\u6765\u53d7\u8a3a\u3001\u96c6\u4e2d\u6cbb\u7642\u5ba4\uff08ICU\uff09\u3078\u306e\u5165\u5ba4\u3001COPD\u306e\u5897\u60aa\u3001\u65e5\u5e38\u751f\u6d3b\u52d5\u4f5c\u3001\u547c\u5438\u56f0\u96e3\u3001\u7761\u7720\u306e\u8cea\u3001\u904b\u52d5\u8010\u5bb9\u80fd\u3001\u6709\u5bb3\u4e8b\u8c61\u3068\u3057\u305f\u3002<\/p>\n

Results<\/strong>
\n21\u4ef6\u306eRCT\u306812\u4ef6\u306e\u89b3\u5bdf\u7814\u7a76\u306e\u5408\u8a0851085\u540d\u306e\u60a3\u8005\uff08\u5e73\u5747\u5e74\u9f6265.7\u6b73\u3001\u5973\u602743\uff05\uff09\u304c\u5bfe\u8c61\u3068\u306a\u3063\u305f\u3002
\n\u6b7b\u4ea1\u8005\u306f434\u540d\u3001\u633f\u7ba1\u3092\u884c\u3063\u305f\u60a3\u8005\u306f27\u540d\u3067\u3042\u3063\u305f\u3002<\/p>\n

BPAP\u3068\u88c5\u7f6e\u306a\u3057\u306e\u6bd4\u8f03<\/span><\/p>\n

\u6b7b\u4ea1\u30ea\u30b9\u30af\u3092\u6709\u610f\u306b\u4f4e\u4e0b\u3055\u305b\u305f\u3002
\n2.31% vs 28.57%\u3001RD-5.53\uff05[95\uff05CI; -10.29\uff05\uff5e-0.76\uff05]\u3001OR0.66 [95\uff05 CI; 0.51\u301c0.87]\u3001P=0.003
\n\u5168\u539f\u56e0\u306b\u3088\u308b\u5165\u9662\u60a3\u8005\u3092\u512a\u4f4d\u306b\u6e1b\u3089\u3057\u305f\u3002
\n39.74\uff05 vs 75.00\uff05\u3001RD-35.26\uff05[95\uff05 CI; -49.39\uff05\u301c-21.12\uff05]\u3001OR0.22[95\uff05 CI; 0.11\u301c0.43]\u3001P<0.001
\n\u633f\u7ba1\u306e\u5fc5\u8981\u6027\u3092\u512a\u4f4d\u306b\u6e1b\u3089\u3057\u305f\u3002
\n5.34\uff05 vs 14.71\uff05\u3001RD-8.02\uff05[95\uff05CI; -14.77\uff05\u301c-1.28\uff05] OR0.34[95\uff05 CI; 0.14\u301c0.83]\u3001P=0.02
\nQOL\u306b\u306f\u6709\u610f\u306a\u5dee\u306f\u898b\u3089\u308c\u306a\u304b\u3063\u305f\u3002<\/p>\n

\u975e\u4fb5\u8972\u7684HMV\u3068\u88c5\u7f6e\u306a\u3057\u306e\u6bd4\u8f03<\/span><\/p>\n

\u6b7b\u4ea1\u30ea\u30b9\u30af\u306b\u6709\u610f\u5dee\u306f\u306a\u304b\u3063\u305f\u3002
\n21.84\uff05 vs 34.09\uff05\u3001RD-11.99\uff05[95\uff05 CI; -24.77\uff05\uff5e0.79\uff05]\u3001OR0.56[95\uff05 CI; 0.29-1.08]\u3001 P=0.49<\/p>\n

\u6709\u5bb3\u4e8b\u8c61<\/span><\/p>\n

NIPPV\u3092\u4f7f\u7528\u3057\u305f\u5834\u5408\u3068\u88c5\u7f6e\u3092\u4f7f\u7528\u3057\u306a\u3044\u5834\u5408\u3068\u6bd4\u8f03\u3057\u3066\u3001\u6709\u610f\u5dee\u306f\u306a\u304b\u3063\u305f\u3002\u91cd\u7be4\u306a\u526f\u4f5c\u7528\u306f\u307b\u3068\u3093\u3069\u306a\u304f\u30010.24\/\u4eba\u3067\u975e\u91cd\u7be4\u306a\u526f\u4f5c\u7528\u304c\u51fa\u73fe\u3001\u591a\u304f\u306f\u76ae\u819a\u75c7\u72b6(\u9854\u9762\u767a\u75b9\u3084\u9f3b\u6f70\u760d)\u3001\u773c\u75c7\u72b6\u3001\u9f3b\u75c7\u72b6\u3060\u3063\u305f\u3002<\/p>\n

Discussion<\/strong>
\nCOPD \u3068\u9ad8CO2\u8840\u75c7\u306e\u60a3\u8005\u3092\u5bfe\u8c61\u3068\u3057\u305f\u3053\u306e\u30e1\u30bf\u30a2\u30ca\u30ea\u30b7\u30b9\u3067\u306f\u3001\u5bb6\u5ead\u7528 BPAP \u306f\u88c5\u7f6e\u3092\u4f7f\u7528\u3057\u306a\u3044\u5834\u5408\u3068\u6bd4\u8f03\u3057\u3066\u3001\u6b7b\u4ea1\u7387\u3001\u5168\u539f\u56e0\u306b\u3088\u308b\u5165\u9662\u3001\u633f\u7ba1\u306e\u30ea\u30b9\u30af\u3092\u4f4e\u4e0b\u3055\u305b\u305f\u304c\u3001QOL \u306b\u306f\u6709\u610f\u306a\u5dee\u306f\u306a\u304b\u3063\u305f\u3002\u975e\u4fb5\u8972\u7684HMV\u306f\u88c5\u7f6e\u3092\u4f7f\u7528\u3057\u306a\u3044\u5834\u5408\u3068\u6bd4\u8f03\u3057\u3066\u3001\u5165\u9662\u30ea\u30b9\u30af\u306e\u4f4e\u4e0b\u3068\u6709\u610f\u306b\u95a2\u9023\u3057\u3066\u3044\u305f\u304c\u3001\u6b7b\u4ea1\u30ea\u30b9\u30af\u306b\u306f\u6709\u610f\u5dee\u304c\u306a\u304b\u3063\u305f\u3002
\n\u3057\u304b\u3057\u3001\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\u306f\u4f4e\uff5e\u4e2d\u7a0b\u5ea6\u3067\u3001QOL\u306b\u95a2\u3059\u308b\u30a8\u30d3\u30c7\u30f3\u30b9\u306f\u4e0d\u5341\u5206\u3067\u3042\u308a\u3001\u3044\u304f\u3064\u304b\u306e\u30a2\u30a6\u30c8\u30ab\u30e0\u306e\u5206\u6790\u306f\u5c11\u6570\u306e\u7814\u7a76\u306b\u57fa\u3065\u3044\u3066\u3044\u305f\u3002
\n\u88c5\u7f6e\u306e\u7a2e\u985e\u3001\u8a2d\u5b9a\u3001PaCO2\u6e1b\u5c11\u306b\u4f34\u3046\u8abf\u6574\u65b9\u6cd5\u306a\u3069\u306b\u3064\u3044\u3066\u306f\u4f9d\u7136\u3068\u3057\u3066\u4e0d\u660e\u3002\u4e00\u90e8\u306e\u7814\u7a76\u3067\u306f\u3001\u3088\u308a\u9ad8\u5f37\u5ea6\u306eNIPPV\u3084\u3001\u8ffd\u52a0\u306e\u30e2\u30fc\u30c9\u3084\u6a5f\u80fd\u3092\u5099\u3048\u305f\u88c5\u7f6e\u3067\u8ee2\u5e30\u306e\u6539\u5584\u304c\u78ba\u8a8d\u3055\u308c\u3066\u3044\u308b\u304c\u3001\u88c5\u7f6e\u306e\u30e2\u30fc\u30c9\u3092\u6bd4\u8f03\u3057\u305f\u4ed6\u306e\u7814\u7a76\u3067\u306f\u8ee2\u5e30\u306e\u9055\u3044\u306f\u78ba\u8a8d\u3055\u308c\u3066\u3044\u306a\u3044\u3002\u307e\u305f\u3001\u3069\u306ePaCO2\u95be\u5024\u3067NIPPV\u3092\u958b\u59cb\u3059\u3079\u304d\u304b\u3001\u95be\u5024\u304c\u4f4e\u304f\u3066\u3082\u81e8\u5e8a\u7684\u306b\u6709\u610f\u306a\u52b9\u679c\u304c\u3042\u308b\u304b\u3069\u3046\u304b\u3082\u4e0d\u660e\u306a\u307e\u307e\u3067\u3042\u308b\u3002\u73fe\u5728\u306e\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3001\u63a8\u5968\u4e8b\u9805\u3001\u5b9f\u65bd\u65b9\u6cd5\u306f\u69d8\u3005\u3067\u3042\u308b\u3002<\/p>\n

\u203b\u65e5\u672c\u306e\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306b\u3064\u3044\u3066\u306f\u4e0b\u56f3\u53c2\u7167
\n\"\"<\/p>\n

NIPPV\u3092\u53d7\u3051\u305f\u60a3\u8005\u306e\u9854\u9762\u767a\u75b9\u3084\u7c98\u819c\u4e7e\u71e5\u306a\u3069\u306e\u975e\u91cd\u7be4\u306a\u6709\u5bb3\u4e8b\u8c61\u306e\u767a\u751f\u7387\u306f25\uff05\u8fd1\u304f\u306b\u53ca\u3093\u3060\u304c\u3001\u91cd\u7be4\u306a\u6709\u5bb3\u4e8b\u8c61\u306f\u307e\u308c\u3067\u3042\u308a\u3001\u767a\u751f\u7387\u306fNIPPV\u3092\u4f7f\u7528\u3057\u305f\u7fa4\u3068\u4f7f\u7528\u3057\u3066\u3044\u306a\u3044\u7fa4\u3068\u3067\u6709\u610f\u5dee\u306f\u306a\u304b\u3063\u305f\u3002<\/p>\n

\"\"<\/p>\n

\"\"<\/p>\n

\u3010\u958b\u50ac\u65e5\u30112021\u5e746\u67089\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

\u2015\u6587\u732e\u540d\u2015 Wilson ME, et al. Association of Home Noninvasive Positive Pressure Ventilation With Clinical Outcomes i … \u7d9a\u304d\u3092\u8aad\u3080 COPD\u60a3\u8005\u3068\u5728\u5b85NPPV<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[22,17],"tags":[],"class_list":["post-2147","post","type-post","status-publish","format-standard","hentry","category-22","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2147","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2147"}],"version-history":[{"count":3,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2147\/revisions"}],"predecessor-version":[{"id":2153,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2147\/revisions\/2153"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2147"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2147"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2147"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}