Schucher B, Zerbst J, Baumann H J
Krankenhaus Grosshansdorf, Zentrum für Pneumologie und Thoraxchirurgie, Grosshansdorf.
Pneumologie. 2004 Jun;58(6):428-34. doi: 10.1055/s-2004-818499.
Noninvasive positive pressure ventilation in patients with stable chronic obstructive pulmonary disease. The role of non-invasive positive pressure ventilation (NIPPV) is well documented in patients with restrictive thoracic diseases like kyphoscoliosis, tuberculosis sequelae or neuromuscular disease. There is also a good evidence for the use of NIPPV in acute respiratory failure in patients with an exacerbation of COPD. The application of NIPPV in patients with chronic respiratory failure is growing, but there is less evidence than in restrictive disorders. NIPPV can unload the respiratory muscles in patients with chronic hypercapnic COPD and so alleviates fatigue of the respiratory pump, but improvement in the maximal inspiratory pressure (Pi (max)) is small or even absent. An improvement of sleep quality has also postulated, there was an increase in total sleep time and sleep effectiveness when using higher inspiratory pressure. An increase of the walking distance was shown in short term studies, only. In most studies, there was an increase in quality of life as a main topic. Mortality was unchanged in the two long-term randomised controlled studies. Current data suggest a possible role of NIPPV in patients with severe hypercapnia. A high effective inspiratory pressure and a ventilator mode with a significant reduction in the work of breathing should be choosen. NIPPV should be started in hospital, a close reassessment must be performed. Patients who accepted NIPPV in the first weeks had a good compliance for long-term use.
稳定期慢性阻塞性肺疾病患者的无创正压通气。无创正压通气（NIPPV）在诸如脊柱后凸侧弯、肺结核后遗症或神经肌肉疾病等限制性胸疾病患者中的作用已有充分记录。在慢性阻塞性肺疾病急性加重患者的急性呼吸衰竭中使用NIPPV也有充分证据。NIPPV在慢性呼吸衰竭患者中的应用正在增加，但证据比在限制性疾病中少。NIPPV可减轻慢性高碳酸血症性慢性阻塞性肺疾病患者的呼吸肌负荷，从而减轻呼吸泵疲劳，但最大吸气压力（Pi（max））的改善很小甚至没有。也有人推测NIPPV可改善睡眠质量，使用较高吸气压力时总睡眠时间和睡眠效率会增加。仅在短期研究中显示步行距离增加。在大多数研究中，生活质量提高是主要主题。两项长期随机对照研究中死亡率未变。目前的数据表明NIPPV在严重高碳酸血症患者中可能发挥作用。应选择具有高有效吸气压力和显著降低呼吸功的通气模式。NIPPV应在医院开始使用，必须进行密切重新评估。在最初几周接受NIPPV的患者长期使用依从性良好。
