Avdeev S N, Tret'iakov A V, Grigor'iants R A, Kutsenko M A, Chuchalin A G
Anesteziol Reanimatol. 1998 May-Jun(3):45-51.
Noninvasive positive pressure ventilation (NPPV) is a life-saving procedure in acute respiratory failure (ARF), but its technique is not yet in routine use in many respiratory centers. We carried out a prospective randomized study comparing the combination of NPPV with conventional therapy (oxygen, bronchodilators, steroids, and theophylline) with conventional therapy alone in patients with acute respiratory failure caused by exacerbation of chronic obstructive pulmonary disease (COPD). A total of 58 patients were recruited from a large group of patients admitted to our hospital between September 1995 and March 1997. Twenty-nine patients were randomly assigned to the NPPV group and 29 to the conventional (non-NPPV) group. The patients were matched for demographic and physiological norm values (mean age 63.4 +/- 5.5 vs. 66.2 +/- 7.1 years, mean FEV1 0.68 +/- 0.15 vs. 0.74 +/- 0.16 L, PaO2 51.4 +/- 6.8 vs. 52.3 +/- 6.5 mm Hg, PaCO2 63.4 +/- 10.9 vs. 64.9 +/- 9.7 mm Hg, and pH 7.28 +/- 0.07 vs. 7.26 +/- 0.06). The outcome end points were needed for endotracheal intubation, length of hospital stay, and incidence of complications. NPPV was administered using BiPAP ventilatory device (Respironics, Inc.) by spontaneous and spontaneous/timed modes via nasal and facial masks. The mean time of NPPV was 29 +/- 25 h. Three patients refused from NPPV because of intolerance of mask or ventilation procedure. Two of them were eventually intubated and one of them died. In patients administered NPPV, we observed a significant rise of pH and fall of PaCO2 after 1 h of ventilation, in contrast to the non-NPPV group (7.34 +/ 0.09 vs. 7.21 +/- 0.08, p < 0.05; 53.2 +/- 10.7 vs. 71.4 +/- 10.2 mm Hg, p < 0.01, respectively). The need in intubation was lower in the NPPV group as compared to the reference group (12 vs. 28%, p = 0.18), mortality rate was higher in the non-NPPV group (31 vs. 8%, p = 0.03), and hospital stay was shorter in NPPV patients (26 +/- 7 vs. 34 +/- 10 days). The incidence of complications was lower in the NPPV group, they were less significant, and did not involve discontinuation of ventilation. Hence, NPPV is a first-line therapy in patients with ARF caused by COPD exacerbation, due to obvious advantages over conventional methods of treatment.
无创正压通气（NPPV）是急性呼吸衰竭（ARF）中的一种挽救生命的治疗方法，但在许多呼吸中心其技术尚未常规应用。我们进行了一项前瞻性随机研究，比较NPPV联合传统治疗（吸氧、支气管扩张剂、类固醇和茶碱）与单纯传统治疗在慢性阻塞性肺疾病（COPD）加重导致急性呼吸衰竭患者中的效果。1995年9月至1997年3月期间，我们从我院收治的大量患者中招募了58例患者。29例患者被随机分配到NPPV组，29例被分配到传统（非NPPV）组。患者在人口统计学和生理正常数值方面相匹配（平均年龄63.4±5.5岁对66.2±7.1岁，平均第1秒用力呼气容积0.68±0.15 L对0.74±0.16 L，动脉血氧分压51.4±6.8 mmHg对52.3±6.5 mmHg，动脉血二氧化碳分压63.4±10.9 mmHg对64.9±9.7 mmHg，pH值7.28±0.07对7.26±0.06）。观察终点为气管插管需求、住院时间和并发症发生率。使用BiPAP通气设备（Respironics公司）通过鼻罩和面罩以自主和自主/定时模式给予NPPV。NPPV的平均时间为29±25小时。3例患者因面罩不耐受或通气过程不耐受而拒绝NPPV。其中2例最终接受了气管插管，1例死亡。与非NPPV组相比，接受NPPV的患者在通气1小时后pH值显著升高，动脉血二氧化碳分压下降（分别为7.34±0.09对7.21±0.08，p<0.05；53.2±10.7对71.4±10.2 mmHg，p<0.01）。NPPV组的插管需求低于参照组（12%对对照28%，p = 0.18），非NPPV组的死亡率较高（31%对8%，p = 0.03），NPPV患者的住院时间较短（26±7天对34±10天）。NPPV组的并发症发生率较低，程度较轻，且未导致通气中断。因此，由于与传统治疗方法相比具有明显优势，NPPV是COPD加重导致ARF患者的一线治疗方法。
