乙酰唑胺治疗慢性阻塞性肺疾病或肥胖低通气综合征并发呼吸衰竭的代谢性碱中毒：一项系统评价

Acetazolamide for metabolic alkalosis complicating respiratory failure with chronic obstructive pulmonary disease or obesity hypoventilation syndrome: a systematic review.

作者信息

Bemand Timothy John, Chatoor Richard, Natale Patrizia, Strippoli Giovanni, Delaney Anthony

机构信息

Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia

Rural Clinical School Wagga Wagga Campus, University of New South Wales, Wagga Wagga, New South Wales, Australia.

出版信息

Thorax. 2023 Oct;78(10):1004-1010. doi: 10.1136/thorax-2023-219988. Epub 2023 May 22.

DOI:10.1136/thorax-2023-219988

PMID:37217290

Abstract

BACKGROUND

Metabolic alkalosis may lead to respiratory inhibition and increased need for ventilatory support or prolongation of weaning from ventilation for patients with chronic respiratory disease. Acetazolamide can reduce alkalaemia and may reduce respiratory depression.

METHODS

We searched Medline, EMBASE and CENTRAL from inception to March 2022 for randomised controlled trials comparing acetazolamide to placebo in patients with chronic obstructive pulmonary disease, obesity hypoventilation syndrome or obstructive sleep apnoea, hospitalised with acute respiratory deterioration complicated by metabolic alkalosis. The primary outcome was mortality and we pooled data using random-effects meta-analysis. Risk of bias was assessed using the Cochrane RoB 2 (Risk of Bias 2) tool, heterogeneity was assessed using the I value and χ test for heterogeneity. Certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology.

RESULTS

Four studies with 504 patients were included. 99% of included patients had chronic obstructive pulmonary disease. No trials recruited patients with obstructive sleep apnoea. 50% of trials recruited patients requiring mechanical ventilation. Risk of bias was overall low to some risk. There was no statistically significant difference with acetazolamide in mortality (relative risk 0.98 (95% CI 0.28 to 3.46); p=0.95; 490 participants; three studies; GRADE low certainty) or duration of ventilatory support (mean difference -0.8 days (95% CI -7.2 to 5.6); p=0.36; 427 participants; two studies; GRADE: low certainty).

CONCLUSION

Acetazolamide may have little impact on respiratory failure with metabolic alkalosis in patients with chronic respiratory diseases. However, clinically significant benefits or harms are unable to be excluded, and larger trials are required.

PROSPERO REGISTRATION NUMBER

CRD42021278757.

摘要

背景

代谢性碱中毒可能导致呼吸抑制，并增加慢性呼吸系统疾病患者对通气支持的需求或延长脱机时间。乙酰唑胺可减轻碱血症，并可能减轻呼吸抑制。

方法

我们检索了从创刊至2022年3月的Medline、EMBASE和CENTRAL数据库，以查找在因急性呼吸恶化并发代谢性碱中毒而住院的慢性阻塞性肺疾病、肥胖低通气综合征或阻塞性睡眠呼吸暂停患者中，比较乙酰唑胺与安慰剂的随机对照试验。主要结局为死亡率，我们使用随机效应荟萃分析对数据进行汇总。使用Cochrane RoB 2（偏倚风险2）工具评估偏倚风险，使用I值和异质性χ检验评估异质性。使用GRADE（推荐分级、评估、制定和评价）方法评估证据的确定性。

结果

纳入了4项研究，共504例患者。纳入患者中99%患有慢性阻塞性肺疾病。没有试验招募阻塞性睡眠呼吸暂停患者。50%的试验招募了需要机械通气的患者。偏倚风险总体为低到有些风险。乙酰唑胺在死亡率方面无统计学显著差异（相对风险0.98（95%CI 0.28至3.46）；p=0.95；490名参与者；3项研究；GRADE低确定性）或通气支持持续时间方面也无显著差异（平均差-0.8天（95%CI -7.2至5.6）；p=0.36；427名参与者；2项研究；GRADE：低确定性）。