無創正壓通氣在慢性阻塞性肺疾病急性發作中應用的系統評價_《中國循證醫學雜志》

作者：

孫捷豪 , 韓寧 , 吳秀英

中國醫科大學盛京醫院麻醉科（沈陽 110004）;

關鍵詞：

慢性阻塞性肺部疾病無創正壓通氣系統評價

DOI：

10.7507/1672-2531.20080241

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目的　系統評價無創正壓通氣在慢性阻塞性肺疾病（COPD）急性發作時應用的效果及其預后。
方法　電子檢索PubMed、EMBASE、Springer、外文生物醫學期刊全文數據庫和CBMdisc、CNKI，檢索時間均從建庫至2008年3月，檢索納入文獻的參考文獻，納入無創正壓通氣（NPPV）用于COPD急性發作的所有隨機對照試驗驗（RCT），并逐個進行質量評價和資料提取，并對缺少重要數據的文獻向作者索取相關參數。統計學分析采用RevMan 4.2.10軟件處理。
結果　共納入19個RCT（1 236 例）。Meta 分析結果顯示：（1）無創通氣vs 常規治療：① 插管率和失敗率：無創組均比常規組發生率低，分別為［RR=0.36，95%CI（0.27，0.49）］和［RR=0.62，95%CI（0.43，0.90）］；② 病死率：無創組總體病死率低于常規組［RR=0.49，95%CI（0.34，0.69）］，③ 治療時間：無創組住院時間短于常規組［WMD= – 3.83，95%CI（– 5.78，– 1.89）］，但兩者ICU 時間無差異；④ 短時間血氣變化：無創組無論在PaO2、PaCO2、還是pH 上，變化均比常規組明顯；⑤ 呼吸頻率的變化：無創組比常規組的變化更加明顯［WMD= – 3.75，95%CI（– 5.48，– 2.03）］；⑥ 病人出院和隨訪時的狀態：從FEV1，pH，PaCO2，PaO2，肺活量上比較，兩者均無差異。（2）無創通氣vs 有創通氣：① 病死率：ICU 和住院期間的病死率無差異；② 并發癥：無創組明顯比有創組低［ RR=0.38，95%CI（0.20，0.73）］；③ 治療時間：在ICU時間、機械通氣時間及撤機時間上，無創組均比有創組短；④ 無創組無論在病人出院時的狀態還是出院后隨訪時的狀態，與有創組相比，差異均無統計學意義。
結論　現有資料證明：在改善插管率、病死率、短時間內的血氣值以及呼吸頻率方面，NPPV優于常規通氣；在治療時間和并發癥發生率上，NPPV 優于有創通氣；在治療效果方面，無創通氣與其它兩組相似。

引用本文： 孫捷豪,韓寧,吳秀英. 無創正壓通氣在慢性阻塞性肺疾病急性發作中應用的系統評價. 中國循證醫學雜志, 2008, 08(12): 1112-1121. doi: 10.7507/1672-2531.20080241 復制

1.	杭燕南. 危重病人的呼吸支持和機械通氣治療. 見: 莊心良,曾因明, 陳伯鑾. 主編. 現代麻醉學. 第3版. 北京: 人民衛生出版社, 2006, 2414-2416.
2.	Avdeev S, Tret’iakov AV, Grigor’iants RA, et al. Study of the use of noninvasive ventilation of the lungs in acute respiratory insufficiency due exacerbation of chronic obstructive pulmonary disease. Anesteziol Reanimatol, 1998, (3): 45-51.
3.	Andrea B, Spagnolatti L, Massobrio M, et al. Short-term effects of expiration under positive pressure in patients with acute exacerbation of chronic obstructive pulmonary disease and mild acidosis requiring non-invasive positive pressure ventilation. Intensive Care Med, 2002, 28: 581-585.
4.	Bott J, Carroll MP, Conway JH, et al. Random controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet, 1993, 341: 1555-1557.
5.	Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med, 1995, 333: 817-822.
6.	Zhou R, Chen P, Luo H, et al. Sequential BiPAP following invasive mechanical ventilation in COPD patients with hypercapnic respirastory failure. Hunan Yi Ke Da Xue Xue Bao, 2001, 26(3): 261-22.
7.	Castillo D, Barrot E, Laserna E, et al. Noninvasive positive pressure ventilation for acute respiratory failure in chronic obstructive pulmonary disease in a general respiratory ward. Med Clin(Barc), 2003, 120(17): 647-651.
8.	Dikensoy O, Ikidag B, Filiz A, et al. Comparison of non-invasive ventilation and standard medical therapy in acute hypercapnic respiratory failure: a randomised controlled study at a tertiary health centre in SE Turkey. Int J Clin Pract, 2002, 56(2): 85-88.
9.	Celikel T, Sungur M, Ceyhan B, et al. Comparison of Noninvasive Positive Pressure Ventilation With Standard Medical Therapy in Hypercapnic Acute Respiratory Failure. Chest, 1998, 114, 1636-1642.
10.	Matuska P, Pilarová O, Merta Z, et al. Non-invasive ventilation support in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Vnitr Lek, 2006, 52(3): 241-248.
11.	Plant P, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards:a multicentre randomised controlled trial. Lancet, 2000, 355: 1931-1935.
12.	Kramer N, Meyer TJ, Meharg J, et al. Randomized prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med, 1995, 151(6): 1799-1806.
13.	Thomas J, Jeffrey D, Joseph P, et al. A Randomized, Prospective Evaluation of Noninvasive Ventilation for Acute Respiratory Failure. Am J Respir Crit Care Med, 2000, 161: 807-813.
14.	Thys F, Roeseler J, Reynaert M, et al. Noninvasive ventilation for acute respiratory failure: a prospective randomised placebocontrolled trial. Eur Respir J, 2002, 20: 545-555.
15.	Collaborative Research Group of Noninvasive Mechanical Ventilation for Chronic Obstructive Pulmonary Disease. Early use of non-invasive positive pressure ventilation for acute exacerbations of chronic obstructive pulmonary disease:a multicentre randomized controlled trial. Chin Med J, 2005, 118(24): 2034-2040.
16.	Barbé F, Togores B, Rubí M, et al. Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure in chronic obstructive pulmonary disease. Eur Respir J, 1996, 9, 1240-1245.
17.	Daskalopoulou E, Teara V, Fekete K, et al. Treatment of acute respiratory failure in COPD patients with positive airway pressure via nasal mask (NPPV). Chest, 1993, 103: 271s.
18.	Bardi G, Pierotello R, Desideri M, et al. Nasal ventilation in COPD exacerbations:Early and late results of a prospective controlled study. Eur Respir J, 2000, 15: 98-104.
19.	Stcfano Nava, Nicolino Ambrosino, Enrico Clini, et al. Noninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease. Annals of Internal Medicine, 1998, 128, 722-728.
20.	Conti G, M Antonelli, P Navalesi, et al. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med, 2002, 28: 1701-1707.
21.	Plant PK, Owen JL, Elliott MW, et al. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome. Thorax, 2001, 56(9): 708-712.

1. 杭燕南. 危重病人的呼吸支持和機械通氣治療. 見: 莊心良,曾因明, 陳伯鑾. 主編. 現代麻醉學. 第3版. 北京: 人民衛生出版社, 2006, 2414-2416.
2. Avdeev S, Tret’iakov AV, Grigor’iants RA, et al. Study of the use of noninvasive ventilation of the lungs in acute respiratory insufficiency due exacerbation of chronic obstructive pulmonary disease. Anesteziol Reanimatol, 1998, (3): 45-51.
3. Andrea B, Spagnolatti L, Massobrio M, et al. Short-term effects of expiration under positive pressure in patients with acute exacerbation of chronic obstructive pulmonary disease and mild acidosis requiring non-invasive positive pressure ventilation. Intensive Care Med, 2002, 28: 581-585.
4. Bott J, Carroll MP, Conway JH, et al. Random controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet, 1993, 341: 1555-1557.
5. Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med, 1995, 333: 817-822.
6. Zhou R, Chen P, Luo H, et al. Sequential BiPAP following invasive mechanical ventilation in COPD patients with hypercapnic respirastory failure. Hunan Yi Ke Da Xue Xue Bao, 2001, 26(3): 261-22.
7. Castillo D, Barrot E, Laserna E, et al. Noninvasive positive pressure ventilation for acute respiratory failure in chronic obstructive pulmonary disease in a general respiratory ward. Med Clin(Barc), 2003, 120(17): 647-651.
8. Dikensoy O, Ikidag B, Filiz A, et al. Comparison of non-invasive ventilation and standard medical therapy in acute hypercapnic respiratory failure: a randomised controlled study at a tertiary health centre in SE Turkey. Int J Clin Pract, 2002, 56(2): 85-88.
9. Celikel T, Sungur M, Ceyhan B, et al. Comparison of Noninvasive Positive Pressure Ventilation With Standard Medical Therapy in Hypercapnic Acute Respiratory Failure. Chest, 1998, 114, 1636-1642.
10. Matuska P, Pilarová O, Merta Z, et al. Non-invasive ventilation support in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Vnitr Lek, 2006, 52(3): 241-248.
11. Plant P, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards:a multicentre randomised controlled trial. Lancet, 2000, 355: 1931-1935.
12. Kramer N, Meyer TJ, Meharg J, et al. Randomized prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med, 1995, 151(6): 1799-1806.
13. Thomas J, Jeffrey D, Joseph P, et al. A Randomized, Prospective Evaluation of Noninvasive Ventilation for Acute Respiratory Failure. Am J Respir Crit Care Med, 2000, 161: 807-813.
14. Thys F, Roeseler J, Reynaert M, et al. Noninvasive ventilation for acute respiratory failure: a prospective randomised placebocontrolled trial. Eur Respir J, 2002, 20: 545-555.
15. Collaborative Research Group of Noninvasive Mechanical Ventilation for Chronic Obstructive Pulmonary Disease. Early use of non-invasive positive pressure ventilation for acute exacerbations of chronic obstructive pulmonary disease:a multicentre randomized controlled trial. Chin Med J, 2005, 118(24): 2034-2040.
16. Barbé F, Togores B, Rubí M, et al. Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure in chronic obstructive pulmonary disease. Eur Respir J, 1996, 9, 1240-1245.
17. Daskalopoulou E, Teara V, Fekete K, et al. Treatment of acute respiratory failure in COPD patients with positive airway pressure via nasal mask (NPPV). Chest, 1993, 103: 271s.
18. Bardi G, Pierotello R, Desideri M, et al. Nasal ventilation in COPD exacerbations:Early and late results of a prospective controlled study. Eur Respir J, 2000, 15: 98-104.
19. Stcfano Nava, Nicolino Ambrosino, Enrico Clini, et al. Noninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease. Annals of Internal Medicine, 1998, 128, 722-728.
20. Conti G, M Antonelli, P Navalesi, et al. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med, 2002, 28: 1701-1707.
21. Plant PK, Owen JL, Elliott MW, et al. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome. Thorax, 2001, 56(9): 708-712.

《中國循證醫學雜志》

無創正壓通氣在慢性阻塞性肺疾病急性發作中應用的系統評價

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《中國循證醫學雜志》

無創正壓通氣在慢性阻塞性肺疾病急性發作中 應用的系統評價

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無創正壓通氣在慢性阻塞性肺疾病急性發作中應用的系統評價

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