Fontana V, Santinelli S, Internullo M, Marinelli P, Sardo L, Alessandrini G, Borgognoni L, Ferrazza A M, Bonini M, Palange P
Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2016;20(1):37-43.
Non-invasive ventilation (NIV) is an effective treatment in patients with acute exacerbation of COPD (AECOPD). However, it may induce post-hypercapnic metabolic alkalosis (MA). This study aims to evaluate the effect of acetazolamide (ACET) in AECOPD patients treated with NIV.
Eleven AECOPD patients, with hypercapnic respiratory failure and MA following NIV, were treated with ACET 500 mg for two consecutive days and compared to a matched control group. Patients and controls were non invasively ventilated in a bilevel positive airway pressure (BiPAP) mode to a standard maximal pressure target of 15-20 cmH2O.
ACET intra-group analysis showed a significant improvement for PaCO2 (63.9 ± 9.8 vs. 54.9 ± 8.3 mmHg), HCO3- (43.5 ± 5.9 vs. 36.1 ± 5.4 mmol/L) and both arterial pH (7.46 ± 0.06 vs. 7.41 ± 0.06) and urinary pH (6.94 ± 0.77 vs 5.80 ± 0.82), already at day 1. No significant changes in endpoints considered were observed in the control group at any time-point. Inter-group analysis showed significant differences between changes in PaCO2 and HCO3- (delta), both at day 1 and 2. Furthermore, the length of NIV treatment was significantly reduced in the ACET group compared to controls (6 ± 8 vs. 19 ± 19 days). No adverse events were recorded in the ACET and control groups.
ACET appears to be effective and safe in AECOPD patients with post-NIV MA.
无创通气（NIV）是慢性阻塞性肺疾病急性加重（AECOPD）患者的一种有效治疗方法。然而，它可能会诱发高碳酸血症后代谢性碱中毒（MA）。本研究旨在评估乙酰唑胺（ACET）在接受NIV治疗的AECOPD患者中的疗效。
11例AECOPD患者，在接受NIV后出现高碳酸血症性呼吸衰竭和MA，连续两天接受500mg ACET治疗，并与匹配的对照组进行比较。患者和对照组采用双水平气道正压（BiPAP）模式进行无创通气，目标最大压力标准为15 - 20cmH₂O。
ACET组内分析显示，第1天时PaCO₂（63.9±9.8 vs. 54.9±8.3mmHg）、HCO₃⁻（43.5±5.9 vs. 36.1±5.4mmol/L）、动脉血pH（7.46±0.06 vs. 7.41±0.06）和尿pH（6.94±0.77 vs 5.80±0.82）均有显著改善。对照组在任何时间点均未观察到所考虑的终点有显著变化。组间分析显示，第1天和第2天，PaCO₂和HCO₃⁻（差值）的变化存在显著差异。此外，与对照组相比，ACET组的NIV治疗时间显著缩短（6±8天 vs. 19±19天）。ACET组和对照组均未记录到不良事件。
ACET在NIV后发生MA的AECOPD患者中似乎有效且安全。
