无创正压通气治疗慢性高碳酸血症性呼吸衰竭合并间质性肺疾病的急性效应。

Acute effects of NPPV in interstitial lung disease with chronic hypercapnic respiratory failure.

机构信息

Fachkrankenhaus Coswig, Dept. of Pulmonology, Centre for Pulmonology and Thoracic Surgery, Coswig, Germany.

出版信息

Respir Med. 2010 Feb;104(2):291-5. doi: 10.1016/j.rmed.2009.09.017. Epub 2009 Oct 17.

DOI:10.1016/j.rmed.2009.09.017

PMID:19837575

Abstract

OBJECTIVE

A case series evaluating the acute effects of noninvasive positive pressure ventilation (NPPV) in patients with chronic hypercapnic respiratory failure (HRF) secondary to interstitial lung diseases (ILD).

PATIENTS AND METHODS

Ten patients with ILD were retrospectively evaluated. All had restrictive lung function (mean TLC, 47.6+/-12.6% predicted) and chronic hypercapnic respiratory failure (mean pH=7.39+/-0.02). Arterial blood gas analysis and lung function were compared before and after the application of controlled pressure-limited NPPV.

RESULTS

Daytime PaCO(2) during spontaneous breathing decreased by 5.4+/-1.3mmHg (95% confidence interval, 4.5-6.3), from 57.7+/-5.1mmHg to 52.3+/-5.9 (p<0.001); while daytime PaO(2) increased by 3.4+/-3.3mmHg (95% confidence interval, 1.0-5.8), from 63.7+/-3.5mmHg to 67.1+/-3.4 (p=0.01); and TLC increased by 3.9+/-4.5% (95% confidence interval, 0.7-7.1), from 47.6+/-12.6%mmHg to 51.5+/-10.0% (p=0.023).

CONCLUSIONS

In patients with ILD and chronic HRF controlled NPPV is tolerated and can acutely improve blood gas levels. Further studies examining the long-term benefits need to be explored.

摘要

目的

评估无创正压通气（NPPV）对继发于间质性肺疾病（ILD）的慢性高碳酸血症性呼吸衰竭（HRF）患者的急性作用的病例系列研究。

患者和方法

回顾性评估了 10 名ILD 患者。所有患者均有限制性肺功能（平均 TLC，47.6+/-12.6%预测值）和慢性高碳酸血症性呼吸衰竭（平均 pH=7.39+/-0.02）。在应用控制压力限制 NPPV 前后比较动脉血气分析和肺功能。

结果

自主呼吸时日间 PaCO2 在 5.4+/-1.3mmHg（95%置信区间，4.5-6.3）范围内下降，从 57.7+/-5.1mmHg 降至 52.3+/-5.9mmHg（p<0.001）；日间 PaO2 升高 3.4+/-3.3mmHg（95%置信区间，1.0-5.8），从 63.7+/-3.5mmHg 升至 67.1+/-3.4mmHg（p=0.01）；TLC 增加 3.9+/-4.5%（95%置信区间，0.7-7.1），从 47.6+/-12.6%升至 51.5+/-10.0%（p=0.023）。