University of Washington and Department of Veterans Affairs, Seattle, Washington.
Ann Am Thorac Soc. 2017 Jul;14(7):1086-1093. doi: 10.1513/AnnalsATS.201701-016FR.
Acetazolamide is a carbonic anhydrase (CA) inhibitor sometimes used as a respiratory stimulant for patients with chronic obstructive pulmonary disease (COPD) with the goal of improving oxygenation, reducing carbon dioxide retention, and aiding liberation from mechanical ventilation and/or attempting to correct a metabolic alkalosis. However, the net effect of CA inhibition is multifactorial and complex, because CA is inhibited in many tissues that may negatively affect the patient with lung disease. The full impact of acetazolamide and other CA inhibitors depends critically on dosing, age, and pulmonary, renal, hepatic, hematological, and respiratory muscle function and reserves. This review examines the literature and indications for acetazolamide use in patients with COPD dating back to its initial release 6 decades ago. There are very few studies specifically designed to address the population with severe COPD, as such patients were frequently excluded from trials. We therefore discuss the complexity of CA inhibition and its potential benefits and dangers and describe ways in which the pathophysiology of patients with severe COPD puts them at considerable risk for serious adverse consequences. We offer guidance on the careful and rational use of acetazolamide in patients with respiratory disorders.
乙酰唑胺是碳酸酐酶（CA）抑制剂，有时被用作慢性阻塞性肺疾病（COPD）患者的呼吸兴奋剂，目的是改善氧合，减少二氧化碳潴留，并帮助脱离机械通气和/或纠正代谢性碱中毒。然而，CA 抑制的净效应是多因素和复杂的，因为 CA 在许多可能对肺病患者产生负面影响的组织中被抑制。乙酰唑胺和其他 CA 抑制剂的全部影响取决于剂量、年龄以及肺、肾、肝、血液和呼吸肌功能和储备。这篇综述回顾了乙酰唑胺在 COPD 患者中的应用文献和适应证，可追溯到它 60 年前首次问世。很少有专门针对严重 COPD 患者的研究，因为这些患者经常被排除在试验之外。因此，我们讨论了 CA 抑制的复杂性及其潜在的益处和危险，并描述了严重 COPD 患者的病理生理学使他们面临严重不良后果的巨大风险的方式。我们提供了关于在呼吸障碍患者中谨慎和合理使用乙酰唑胺的指导。
