早期给予乙酰唑胺对慢性阻塞性肺疾病或肥胖低通气综合征合并代谢性碱中毒患者机械通气时间的影响。一项随机试验。

Effects of early administration of acetazolamide on the duration of mechanical ventilation in patients with chronic obstructive pulmonary disease or obesity-hypoventilation syndrome with metabolic alkalosis. A randomized trial.

作者信息

Rialp Cervera G, Raurich Puigdevall J M, Morán Chorro I, Martín Delgado M C, Heras la Calle G, Mas Serra A, Vallverdú Perapoch I

机构信息

Intensive Care Department, Hospital Son Llàtzer, carretera de Manacor, km 4, 07198 Palma de Mallorca, Spain.

Intensive Care Department, Hospital Son Espases, carretera de Valldemossa, 79, 07010 Palma de Mallorca, Spain.

出版信息

Pulm Pharmacol Ther. 2017 Jun;44:30-37. doi: 10.1016/j.pupt.2017.03.002. Epub 2017 Mar 7.

DOI:10.1016/j.pupt.2017.03.002

PMID:28286047

Abstract

BACKGROUND

Metabolic alkalosis (MA) inhibits respiratory drive and may delay weaning from mechanical ventilation (MV). MA is common in CO-retainer patients that need MV. Acetazolamide (ACTZ) decreases serum bicarbonate concentration and stimulates respiratory drive. This study evaluated the effects of ACTZ on the duration of MV in patients with MA and COPD or obesity hypoventilation syndrome (OHS) intubated with acute respiratory failure.

METHODS

Multicenter, randomized, controlled, double-blind study, with COPD or OHS patients with MV < 72 h and initial bicarbonate >28 mmol/L and pH > 7.35. Test-treatment, ACTZ 500 mg or placebo, was daily administered if pH > 7.35 and bicarbonate >26 mmol/L. Clinical, respiratory and laboratory parameters were recorded.

RESULTS

47 patients (36 men) were randomized. There were no significant differences between groups in comorbidities, baseline characteristics or arterial blood gases at inclusion. The mean difference in the duration of MV between placebo and ACTZ group was 1.3 days (95%CI, -2.1-4.8; p = 0.44). Kaplan-Meier curves showed no differences in the duration of MV (Log-Rank p = 0.41). Between-group comparison of estimated marginal means (CI 95%) during MV were, respectively: PaCO 55 (51-59) vs 48 (47-50) mm Hg, p = 0.002; bicarbonate concentration 34 (32-35) vs 29 (28-30) mmol/L, p < 0.0001; and minute volume 9.7 (8.9-10.4) vs 10.6 (9.2-12.0) L/min, p = 0.26. There were no severe adverse effects with ACTZ administration.

CONCLUSIONS

Among patients with MA and COPD or OHS, early treatment with ACTZ did not shorten significantly the duration of MV compared with placebo.

TRIAL REGISTRY

clinical.trials.gov; NCT01499485; URL:.www.clinicaltrials.gov.

摘要

背景

代谢性碱中毒（MA）会抑制呼吸驱动，并可能延迟机械通气（MV）撤机。MA在需要MV的二氧化碳潴留患者中很常见。乙酰唑胺（ACTZ）可降低血清碳酸氢盐浓度并刺激呼吸驱动。本研究评估了ACTZ对MA合并慢性阻塞性肺疾病（COPD）或肥胖低通气综合征（OHS）且因急性呼吸衰竭插管患者MV持续时间的影响。

方法

多中心、随机、对照、双盲研究，纳入MV时间<72小时、初始碳酸氢盐>28 mmol/L且pH>7.35的COPD或OHS患者。若pH>7.35且碳酸氢盐>26 mmol/L，则每日给予试验治疗药物ACTZ 500 mg或安慰剂。记录临床、呼吸和实验室参数。

结果

47例患者（36例男性）被随机分组。两组在合并症、基线特征或入组时的动脉血气方面无显著差异。安慰剂组和ACTZ组MV持续时间的平均差异为1.3天（95%CI，-2.1-4.8；p = 0.44）。Kaplan-Meier曲线显示MV持续时间无差异（对数秩检验p = 0.41）。MV期间估计边际均值的组间比较（95%CI）分别为：动脉血二氧化碳分压（PaCO₂）55（51-59）mmHg对48（47-50）mmHg，p = 0.002；碳酸氢盐浓度34（32-35）mmol/L对29（28-30）mmol/L，p<0.0001；分钟通气量9.7（8.9-10.4）L/min对10.6（9.2-12.0）L/min，p = 0.26。给予ACTZ未出现严重不良反应。