Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Chin Med J (Engl). 2011 Dec;124(23):4063-70.
The evidence for non-invasive positive pressure ventilation (NIPPV) used in patients with severe stable chronic obstructive pulmonary disease (COPD) is insufficient. The aim of the meta-analysis was to assess the treatment effects of long-term NIPPV on gas change, lung function, health-related quality of life (HRQL), survival and mortality in severe stable COPD patients.
Randomized controlled trials (RCTs) and crossover studies comparing the treatment effects of NIPPV with conventional therapy were identified from electronic databases and reference lists from January 1995 to August 2010. Two reviewers independently assessed study quality. Data were combined using Review Manager 5.0. Both pooled effects and 95% confidence intervals were calculated.
Five RCTs and one randomized crossover study with a total of 383 severe stable COPD patients were included. NIPPV improved gas change significantly when using a higher inspiratory positive airway pressures. The weighted mean difference (WMD) for the partial pressure of carbon dioxide in artery (PaCO2) was -3.52 (-5.26, -1.77) mmHg and for the partial pressure of oxygen in artery (PaO2) 2.84 (0.23, 5.44) mmHg. There were significant improvements in dyspnea and sleep quality, but gained no benefits on lung function. The standardized mean difference (SMD) for the forced expiratory volume in 1 second (FEV(1)) was 0.00 (0.29, 0.29). And the benefits for exercise tolerance, mood, survival and mortality remained unclear.
Patients with severe stable COPD can gain some substantial treatment benefits when using NIPPV, especially improvements in gas change, dyspnea and sleep quality. Studies of high methodological quality with large population, especially those based on a higher inspiratory positive airway pressures are required to provide more evidences.
无创正压通气（NIPPV）用于治疗重度稳定期慢性阻塞性肺疾病（COPD）的证据尚不充分。本研究的目的是评估长期 NIPPV 对重度稳定期 COPD 患者的气体交换、肺功能、健康相关生活质量（HRQL）、生存率和死亡率的影响。
从电子数据库和参考文献中检索了 1995 年 1 月至 2010 年 8 月的随机对照试验（RCT）和交叉研究，以评估 NIPPV 与常规治疗的疗效。两名评价员独立评估研究质量。采用 Review Manager 5.0 软件进行数据分析。同时计算合并效应值及其 95%可信区间。
共纳入 5 项 RCT 和 1 项随机交叉研究，共 383 例重度稳定期 COPD 患者。使用较高的吸气正压通气时，NIPPV 可显著改善患者的气体交换。动脉血二氧化碳分压（PaCO2）的加权均数差（WMD）为-3.52（-5.26，-1.77）mmHg，动脉血氧分压（PaO2）的 WMD 为 2.84（0.23，5.44）mmHg。NIPPV 还可显著改善呼吸困难和睡眠质量，但对肺功能无明显影响。第 1 秒用力呼气量（FEV1）的标准化均数差（SMD）为 0.00（0.29，0.29）。NIPPV 对运动耐量、情绪、生存率和死亡率的影响仍不明确。
对于重度稳定期 COPD 患者，NIPPV 治疗可能带来显著的临床获益，特别是改善气体交换、呼吸困难和睡眠质量。但仍需要开展方法学质量较高、纳入更多患者的研究，以提供更有力的证据。
