Ortega González Angel, Peces-Barba Romero Germán, Fernández Ormaechea Itziar, Chumbi Flores René, Cubero de Frutos Noelia, González Mangado Nicolás
Servicio de Neumología, Fundación Jiménez Díaz, Madrid, España.
Arch Bronconeumol. 2006 Sep;42(9):423-9. doi: 10.1016/s1579-2129(06)60563-6.
We compared the use of noninvasive ventilation (NIV) for hypercapnic acidosis with hypoxemia in patients with chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), or congestive heart failure (CHF) in a respiratory medicine monitoring unit. The objective was to evaluate each diagnostic groups response to therapy in terms of clinical course and evolution of blood gases.
Prospective, 12-month study of 53 patients with hypercapnic acidosis with hypoxemia. Twenty-seven patients had COPD, 17 OHS, and 9 CHF. Severity was assessed based on initial arterial blood gas analysis. Clinical course was studied by blood gas analysis after conventional treatment and after NIV (1-3 hours and 12-24 hours). Mortality was recorded. All patients received bilevel positive airway pressure support in assist-control mode.
No significant differences were observed between mean (SD) initial pH findings in the 3 diagnostic groups: COPD, 7.28 (0.1); OHS, 7.29 (0.09); and CHF, 7.24 (0.07). (nonsignificant differences). After initial conventional treatment, PaCO2 worsened for COPD patients (P = .026) and PaO2 improved for CHF patients (P = .028). After 1 to 3 hours of NIV, pH (P = .002) and PaO2 (P = .041) improved for COPD patients, and pH (P = .03) and PaCO2 (P = .045) improved in OHS patients; no significant changes were observed in CHF patients. After 12 to 24 hours of NIV, the mean pH was 7.36 (0.04) for COPD patients, 7.36 (0.05) for OHS patients, and 7.25 (0.1) for CHF patients (not significant). The mortality rate was 11.1% for COPD, 0% for OHS, and 33.3% for CHS (not significant, P = .076).
In this group of patients with similar initial arterial blood gas values, response to NIV was seen to be better in OHS and COPD than in CHF. That the start of NIV is usually preceded by a poor response to conventional COPD treatment suggests that delaying NIV should be reconsidered.
我们在呼吸内科监测病房比较了无创通气（NIV）用于慢性阻塞性肺疾病（COPD）、肥胖低通气综合征（OHS）或充血性心力衰竭（CHF）合并高碳酸血症性酸中毒伴低氧血症患者的情况。目的是根据临床病程和血气变化评估各诊断组对治疗的反应。
对53例高碳酸血症性酸中毒伴低氧血症患者进行为期12个月的前瞻性研究。27例患者患有COPD，17例患有OHS，9例患有CHF。根据初始动脉血气分析评估严重程度。通过常规治疗后以及NIV（1 - 3小时和12 - 24小时）后的血气分析研究临床病程。记录死亡率。所有患者均接受双水平气道正压通气辅助控制模式支持。
在3个诊断组中，平均（标准差）初始pH值未见显著差异：COPD患者为7.28（0.1）；OHS患者为7.29（0.09）；CHF患者为7.24（0.07）（差异无统计学意义）。初始常规治疗后，COPD患者的PaCO₂恶化（P = 0.026），CHF患者的PaO₂改善（P = 0.028）。NIV治疗1至3小时后，COPD患者的pH（P = 0.002）和PaO₂（P = 0.041）改善，OHS患者的pH（P = 0.03）和PaCO₂（P = 0.045）改善；CHF患者未见显著变化。NIV治疗12至24小时后，COPD患者的平均pH为7.36（0.04），OHS患者为7.36（0.05），CHF患者为7.25（0.1）（差异无统计学意义）。COPD患者的死亡率为11.1%，OHS患者为0%，CHF患者为33.3%（差异无统计学意义，P = 0.076）。
在这组初始动脉血气值相似的患者中，OHS和COPD患者对NIV的反应优于CHF患者。NIV开始前通常对常规COPD治疗反应不佳，这表明应重新考虑延迟NIV的做法。
