Liao Hao, Pei Wendi, Li Hongfu, Luo Yuwen, Wang Kai, Li Rui, Xu Limei, Chen Xin
Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2017 Oct 10;12:2977-2985. doi: 10.2147/COPD.S148422. eCollection 2017.
The efficacy of long-term noninvasive positive pressure ventilation (NPPV) in stable hypercapnic COPD patients with respiratory failure remains unclear. The aim of this meta-analysis was to critically assess the efficacy of long-term NPPV on mortality, acute exacerbation, exercise capacity, symptoms and significant physiological parameters (lung function, respiratory muscle function and gas exchange).
We performed an electronic literature search using the PubMed, Cochrane Library, Embase, OVID and Chinese Biomedical Literature Database in May 2017. Studies comparing treatment effects of NPPV with oxygen therapy in stable hypercapnic COPD patients with respiratory failure were conducted, and at least one of the following parameters were reviewed: frequency of acute exacerbation, mortality, lung function, respiratory muscle function, gas exchange, exercise capacity.
Seven studies with 810 subjects were identified. The partial pressure of arterial carbon dioxide (PaCO) significantly decreased in patients who received long-term NPPV (weighted mean difference [WMD] -3.73, 95% CI: -5.83 to -1.64, =0.0005). No significant difference was found in mortality, partial pressure of arterial oxygen (PaO), frequency of acute exacerbation, lung function, respiratory muscle function and exercise capacity. The subgroup analysis showed that NPPV significantly improved the survival of patients when it was targeted at greatly reducing hypercapnia (WMD 0.35, 95% CI: 0.19 to 0.64, =0.0006).
The results indicate that long-term NPPV decreases the PaCO of stable hypercapnic COPD patients with respiratory failure and improves mortality with the aim of reducing PaCO.
长期无创正压通气（NPPV）对稳定期高碳酸血症性慢性阻塞性肺疾病（COPD）呼吸衰竭患者的疗效尚不清楚。本荟萃分析的目的是严格评估长期NPPV对死亡率、急性加重、运动能力、症状及重要生理参数（肺功能、呼吸肌功能和气体交换）的疗效。
我们于2017年5月使用PubMed、Cochrane图书馆、Embase、OVID和中国生物医学文献数据库进行了电子文献检索。纳入了比较NPPV与氧疗对稳定期高碳酸血症性COPD呼吸衰竭患者治疗效果的研究，并对以下至少一项参数进行了评估：急性加重频率、死亡率、肺功能、呼吸肌功能、气体交换、运动能力。
共纳入7项研究，810名受试者。接受长期NPPV治疗的患者动脉血二氧化碳分压（PaCO）显著降低（加权均数差[WMD] -3.73，95%可信区间：-5.83至-1.64，P = 0.0005）。在死亡率、动脉血氧分压（PaO）、急性加重频率、肺功能、呼吸肌功能和运动能力方面未发现显著差异。亚组分析显示，当NPPV旨在大幅降低高碳酸血症时，可显著提高患者生存率（WMD 0.35，95%可信区间：0.19至0.64，P = 0.0006）。
结果表明，长期NPPV可降低稳定期高碳酸血症性COPD呼吸衰竭患者的PaCO，并以降低PaCO为目标提高生存率。
