重度稳定型COPD可从NIPPV中获益

亚特兰大——针对13项随机对照临床试验、582例患者的系统综述显示，长期夜间使用无创正压通气(NIPPV)可显著降低重度稳定型慢性阻塞性肺病(COPD)患者入住重症监护(ICU)病房的几率。

巴弗洛大学的Monali Patil博士从1991~2011年期间700多项COPD研究中选取了13项符合标准的随机对照临床试验，所招募的COPD患者均为第1秒用力呼气量(FEV₁)＜50%预测值、PCO₂＞45 mmHg、正在接受双水平正压通气(BIPAP)。受试患者的年龄为18~75岁，在入组前2周内无COPD急性加重。

Patil博士在美国胸内科医师协会(ACCP)年会上报告，1年之后，与标准药物治疗相比，NIPPV治疗与ICU入住率显著降低相关[比值比(OR)，0.41]。使用NIPPV超过3个月的患者，还在氧合改善(平均差为-2.43 mmHg)、PCO₂降低(平均差为-2.96 mmHg)和6分钟步行距离提高(平均差为45.15 m)等方面表现出优势。

NIPPV组患者表现出1年死亡率较低的趋势，但未达到统计学显著性，肺功能的改善也不够显著。

Patil博士指出，临床上对于NIPPV在重度稳定型COPD患者中的长期使用存在争议，而上述发现表明该疗法获益明显。“因此，NIPPV可以作为重度稳定型COPD的辅助治疗手段。”

Patil博士报告称无相关利益冲突。

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By: SHARON WORCESTER, Internal Medicine News Digital Network

ATLANTA  – Long-term nocturnal use of noninvasive positive pressure ventilation significantly reduced the likelihood of intensive care unit admission in patients with severe stable chronic obstructive pulmonary disease, according to findings from a systematic review of 582 patients in 13 randomized, controlled clinical trials.

After 1 year, noninvasive positive pressure ventilation (NIPPV) was associated with a significant decrease in ICU admissions (odds ratio, 0.41) compared with standard medical therapy. Patients using NIPPV for more than 3 months also had improvements in oxygenation (mean difference of -2.43 mm Hg), reduction in PCO2 (mean difference, -2.96 mm Hg), and an improvement in 6-minute walk distance (mean difference 45.15 m), Dr. Monali Patil reported at the annual meeting of the American College of Chest Physicians.

A trend toward improved mortality at 1 year did not reach statistical significance, and no significant improvements in lung function were noted, said Dr. Patil of the University at Buffalo (N.Y.).

Dr. Patil selected the 13 trials from a review of more than 700 studies conducted between 1991 and 2011. The analysis included only randomized, controlled trials of COPD patients who had an FEV1 less than 50% of predicted and a PCO2 greater than 45 mm Hg and were receiving bilevel positive airway pressure (BIPAP). The patients in the studies were aged 18-75 years, and had no COPD exacerbations within 2 weeks prior to study enrollment.

The long-term use of NIPPV in patients with severe stable COPD has been controversial, but these findings demonstrate significant benefits.

"So NIPPV can be used as adjuvant treatment for management of severe stable COPD patients," she concluded.

Dr Patil reported having no financial disclosures.