Gantzhorn Eline K, Prior Thomas Skovhus, Hilberg Ole
Lillebaelt Hospital, University Hospital of Southern Denmark, Odense, Denmark.
Aarhus University Hospital, Aarhus Denmark, Aarhus, Denmark.
Eur Clin Respir J. 2019 Jul 23;6(1):1644893. doi: 10.1080/20018525.2019.1644893. eCollection 2019.
: Long-term non-invasive ventilation (LTNIV) for the stable hypercapnic chronic obstructive pulmonary disease (COPD)-patients have been a subject of much debate in the last two decades. The aim of this study was to compile the current knowledge on LTNIV in order to evaluate the effects on mortality and hypercapnia. : Literature search in Pubmed, Ovid, and Embase for RCTs in Humans from January 2000 through January 2019 in written English. : Six studies with a total of 861 patients were included. LTNIV in stable hypercapnic COPD patients significantly reduced PaCO but only one study found significant reduction in mortality. : Our meta-analyses demonstrate that LTNIV significantly reduced PaCO in stable patients with chronic hypercapnic respiratory failure compared to standard care alone, and subgroup analyses on studies with a predefined plan for ventilation, showed a considerable trend towards significant reduction in mortality. The take home messages on LTNIV in stable hypercapnic COPD are: It is essential that the patients have stable chronic hypercapnia.The degree of stability can best be assessed after a minimum of 2 weeks following an acute hypercapnic respiratory failure (AHRF).It is important to ventilate the patient with the goal to reduce PaCO by at least 20% or below 6.5 kPa.
在过去二十年中，长期无创通气（LTNIV）用于稳定期高碳酸血症慢性阻塞性肺疾病（COPD）患者一直是备受争议的话题。本研究的目的是汇总关于长期无创通气的现有知识，以评估其对死亡率和高碳酸血症的影响。：于2000年1月至2019年1月期间在Pubmed、Ovid和Embase中检索以英文撰写的关于人类随机对照试验（RCT）的文献。：纳入了六项研究，共861例患者。稳定期高碳酸血症COPD患者使用长期无创通气可显著降低动脉血二氧化碳分压（PaCO），但仅有一项研究发现死亡率有显著降低。：我们的荟萃分析表明，与单纯标准治疗相比，长期无创通气可显著降低稳定期慢性高碳酸血症呼吸衰竭患者的PaCO，并且对具有预先设定通气计划的研究进行亚组分析显示，死亡率有显著降低的明显趋势。关于稳定期高碳酸血症COPD患者长期无创通气的关键信息如下：患者必须患有稳定的慢性高碳酸血症。在急性高碳酸血症呼吸衰竭（AHRF）后至少2周，才能最好地评估稳定程度。以将PaCO降低至少20%或降至6.5 kPa以下为目标对患者进行通气很重要。
