无创通气治疗慢性阻塞性肺疾病急性加重伴极高动脉血二氧化碳分压（PaCO₂）：一项随机对照试验。

Non-invasive ventilation for acute exacerbation of COPD with very high PaCO(2): A randomized controlled trial.

作者信息

Khilnani Gopi C, Saikia Nripen, Banga Amit, Sharma Surendra K

机构信息

Department of Medicine, All India Institute of Medical Sciences, New-Delhi, India.

出版信息

Lung India. 2010 Jul;27(3):125-30. doi: 10.4103/0970-2113.68308.

DOI:10.4103/0970-2113.68308

PMID:20931029

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2946712/

Abstract

OBJECTIVE

To assess the role of non-invasive positive pressure ventilation (NIPPV) for management of Indian patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

MATERIALS AND METHODS

Forty patients (mean age 57.6 ± 10.8 years; M:F 31:9) with AECOPD with pH <7.35, admitted to the intensive care unit were included. Patients were randomized to receive NIPPV (N, n = 20) with conventional therapy or conventional therapy (C, n = 20) alone at admission. NIPPV was given through the nasal mask. Incidence of need of endotracheal intubation (ETI) was the primary efficacy variable. Hospital mortality, duration of hospital stay and change in clinical and blood gas parameters were the secondary outcome variables.

RESULTS

Mean pH at baseline for N and C groups were similar (7.23 ± 0.07) whereas PaCO(2) was 85.4 ± 14.8 and 81.1 ± 11.6 mm of Hg, respectively. At one hour, patients in N group had greater improvement in pH (P = 0.017) as well as PaCO(2) (P = 0.04) which corroborated with clinical improvement. Whereas need of ETI was reduced in patients who received NIPPV (3/20 vs 12/20, P = 0.003), in-hospital mortality was similar (3/20 and 2/20, P = NS). The mean duration of hospital stay was significantly shorter in N group (9.4 ± 4.3 days) as compared to C group (17.8 ± 2.6 days); P = 0.001.

CONCLUSIONS

In patients with AECOPD, NIPPV leads to rapid improvement in blood gas parameters and reduces the need for ETI.

摘要

目的

评估无创正压通气（NIPPV）在治疗印度慢性阻塞性肺疾病急性加重期（AECOPD）患者中的作用。

材料与方法

纳入40例入住重症监护病房、pH<7.35的AECOPD患者（平均年龄57.6±10.8岁；男:女=31:9）。患者在入院时随机分为接受NIPPV联合传统治疗组（N组，n=20）或单纯传统治疗组（C组，n=20）。通过鼻面罩给予NIPPV。气管插管（ETI）需求发生率是主要疗效变量。医院死亡率、住院时间以及临床和血气参数的变化是次要结局变量。

结果

N组和C组基线时的平均pH值相似（7.23±0.07），而动脉血二氧化碳分压（PaCO₂）分别为85.4±14.8和81.1±11.6mmHg。1小时时，N组患者的pH值（P=0.017）和PaCO₂（P=0.04）改善更明显，这与临床改善情况相符。接受NIPPV的患者ETI需求减少（3/20 vs 12/20，P=0.003），但住院死亡率相似（3/20和2/20，P=无统计学意义）。N组的平均住院时间（9.4±4.3天）明显短于C组（17.8±2.6天）；P=0.001。