Windisch Wolfram, Kostić Sergej, Dreher Michael, Virchow Johann Christian, Sorichter Stephan
Department of Pneumology, University Hospital Freiburg, Killianstrasse 5, D - 79106 Freiburg, Germany.
Chest. 2005 Aug;128(2):657-62. doi: 10.1378/chest.128.2.657.
The role of noninvasive positive pressure ventilation (NPPV) has been well established in the treatment of acute hypercapnic respiratory failure due to COPD. However, evidence for a sustained improvement in blood gas levels and survival in patients with stable hypercapnic COPD following NPPV is still lacking. There is concern that this might be due to low inspiratory pressures of < 18 cm H2O used in previous studies, which thereby did not achieve a reduction of Pa(CO2). Therefore, the 2-year survival and changes in lung function and blood gas levels were analyzed in patients with stable hypercapnic COPD in whom controlled pressure-limited NPPV was titrated to achieve a maximal improvement in Pa(CO2).
Retrospective study between March 1997 and September 2003.
General ward of a university hospital.
Thirty-four consecutive patients with stable (mean pH 7.40 +/- 0.03) hypercapnic COPD (mean age, 63.4 +/- 9.7 years [+/- SD]; mean body mass index, 28.3 +/- 7.3 kg/m2).
Daytime Pa(CO2) during spontaneous breathing decreased by 6.9 +/- 8.0 (95% confidence interval, - 9.9 to - 3.9), from 53.3 +/- 4.8 to 46.4 +/- 7.0 mm Hg (p < 0.001); while daytime Pa(O2) increased by 5.8 +/- 9.4 (95% confidence interval, 2.3 to 9.3), from 51.7 +/- 8.8 to 57.5 +/- 9.3 mm Hg (p = 0.002); and FEV1 increased by 0.14 +/- 0.16 (95% confidence interval, 0.08 to 0.20), from 1.03 +/- 0.54 to 1.17 +/- 0.59 L (p < 0.001) after 2 months of NPPV. This was achieved with mean inspiratory pressures of 27.7 +/- 5.9 cm H2O (range, 17 to 40 cm H2O) at a mean respiratory rate of 20.8 +/- 2.5 breaths/min (range, 14 to 24 breaths/min). The 2-year survival rate was 86%.
Controlled NPPV using a mean inspiratory pressure of 28 cm H2O is well tolerated over longer periods and can improve blood gas levels and lung function. Prospective, randomized controlled trials of high-intensity NPPV are required to evaluate its role in patients with stable hypercapnic COPD.
无创正压通气（NPPV）在慢性阻塞性肺疾病（COPD）所致急性高碳酸血症呼吸衰竭的治疗中作用已得到充分证实。然而，对于稳定期高碳酸血症COPD患者接受NPPV治疗后血气水平持续改善及生存率提高的证据仍不足。有人担心这可能是由于既往研究中使用的吸气压力<18 cm H₂O较低，从而未能实现动脉血二氧化碳分压（Pa(CO₂)）的降低。因此，对稳定期高碳酸血症COPD患者进行了分析，这些患者接受控制性压力限制NPPV治疗，以使Pa(CO₂)得到最大程度改善，并观察其2年生存率以及肺功能和血气水平的变化。
1997年3月至2003年9月的回顾性研究。
一所大学医院的普通病房。
34例连续的稳定期（平均pH值7.40±0.03）高碳酸血症COPD患者（平均年龄63.4±9.7岁[±标准差]；平均体重指数28.3±7.3 kg/m²）。
NPPV治疗2个月后，自主呼吸时的日间Pa(CO₂)从53.3±4.8降至46.4±7.0 mmHg，下降了6.9±8.0（95%置信区间，-9.9至-3.9）（p<0.001）；日间Pa(O₂)从51.7±8.8升至57.5±9.3 mmHg，升高了5.8±9.4（95%置信区间，2.3至9.3）（p = 0.002）；第1秒用力呼气容积（FEV₁）从1.03±0.54升至1.17±0.59 L，增加了0.14±0.16（95%置信区间，0.08至0.20）（p<0.001）。实现这些变化的平均吸气压力为27.7±5.9 cm H₂O（范围，17至40 cm H₂O），平均呼吸频率为20.8±2.5次/分钟（范围，14至24次/分钟）。2年生存率为86%。
使用平均吸气压力28 cm H₂O的控制性NPPV在较长时间内耐受性良好，可改善血气水平和肺功能。需要进行高强度NPPV的前瞻性随机对照试验，以评估其在稳定期高碳酸血症COPD患者中的作用。
