无创正压通气在慢性阻塞性肺疾病急性发作中应用的系统评价_《中国循证医学杂志》

作者：

孙捷豪 , 韩宁 , 吴秀英

中国医科大学盛京医院麻醉科（沈阳 110004）;

关键词：

慢性阻塞性肺部疾病无创正压通气系统评价

DOI：

10.7507/1672-2531.20080241

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价无创正压通气在慢性阻塞性肺疾病（COPD）急性发作时应用的效果及其预后。
方法　电子检索PubMed、EMBASE、Springer、外文生物医学期刊全文数据库和CBMdisc、CNKI，检索时间均从建库至2008年3月，检索纳入文献的参考文献，纳入无创正压通气（NPPV）用于COPD急性发作的所有随机对照试验验（RCT），并逐个进行质量评价和资料提取，并对缺少重要数据的文献向作者索取相关参数。统计学分析采用RevMan 4.2.10软件处理。
结果　共纳入19个RCT（1 236 例）。Meta 分析结果显示：（1）无创通气vs 常规治疗：① 插管率和失败率：无创组均比常规组发生率低，分别为［RR=0.36，95%CI（0.27，0.49）］和［RR=0.62，95%CI（0.43，0.90）］；② 病死率：无创组总体病死率低于常规组［RR=0.49，95%CI（0.34，0.69）］，③ 治疗时间：无创组住院时间短于常规组［WMD= – 3.83，95%CI（– 5.78，– 1.89）］，但两者ICU 时间无差异；④ 短时间血气变化：无创组无论在PaO2、PaCO2、还是pH 上，变化均比常规组明显；⑤ 呼吸频率的变化：无创组比常规组的变化更加明显［WMD= – 3.75，95%CI（– 5.48，– 2.03）］；⑥ 病人出院和随访时的状态：从FEV1，pH，PaCO2，PaO2，肺活量上比较，两者均无差异。（2）无创通气vs 有创通气：① 病死率：ICU 和住院期间的病死率无差异；② 并发症：无创组明显比有创组低［ RR=0.38，95%CI（0.20，0.73）］；③ 治疗时间：在ICU时间、机械通气时间及撤机时间上，无创组均比有创组短；④ 无创组无论在病人出院时的状态还是出院后随访时的状态，与有创组相比，差异均无统计学意义。
结论　现有资料证明：在改善插管率、病死率、短时间内的血气值以及呼吸频率方面，NPPV优于常规通气；在治疗时间和并发症发生率上，NPPV 优于有创通气；在治疗效果方面，无创通气与其它两组相似。

引用本文： 孙捷豪,韩宁,吴秀英. 无创正压通气在慢性阻塞性肺疾病急性发作中应用的系统评价. 中国循证医学杂志, 2008, 08(12): 1112-1121. doi: 10.7507/1672-2531.20080241 复制

1.	杭燕南. 危重病人的呼吸支持和机械通气治疗. 见: 庄心良,曾因明, 陈伯銮. 主编. 现代麻醉学. 第3版. 北京: 人民卫生出版社, 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机械通气治疗. 见: 庄心良,曾因明, 陈伯銮. 主编. 现代麻醉学. 第3版. 北京: 人民卫生出版社, 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.

《中国循证医学杂志》

无创正压通气在慢性阻塞性肺疾病急性发作中应用的系统评价

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《中国循证医学杂志》

无创正压通气在慢性阻塞性肺疾病急性发作中 应用的系统评价

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无创正压通气在慢性阻塞性肺疾病急性发作中应用的系统评价

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