摘要
本研究以前瞻性、随机和对照的方式评估无创通气支持(NIVS) +双水平气道正压(BiPAP)是否有助于慢性阻塞性肺疾病(COPD)患者急性呼吸衰竭(ARF)的康复。24例COPD患者(平均年龄(+/- sem) 68 +/- 2岁)(出院时1秒用力呼气量(FEV1)预测为33 +/- 2%),因ARF入院(pH 7.33 +/- 0.01;动脉氧张力(Pa,O2) 6.0 +/- 0.2 kPa;动脉二氧化碳张力(Pa,CO2) 7.9 +/- 0.3 kPa),初始随机化。接受NIVS治疗的14例患者中有4例(29%)无法忍受NIVS。其余20例患者中,10例在住院前3天在常规医院病房接受NIVS和BiPAP治疗(两次日间治疗,每次3小时)。所有20名受试者都接受了氧气、支气管扩张剂和类固醇治疗。在住院的第1天和第3天,停用氧疗和/或BiPAP通气支持前和后30分钟,我们测量了呼气峰流量、动脉血气值、通气模式、闭塞压(P0.1)、最大吸气(MIP)和最大呼气压(MEP)。所有患者出院时均不需要气管插管和机械通气。两组患者的住院时间相似(11.3 +/- 1.3天vs 10.6 +/- 0.9天,对照组vs BiPAP)。 Arterial oxygenation, respiratory acidosis and airflow obstruction improved significantly throughout hospitalization in both groups. By contrast, the ventilatory pattern, P0.1, MIP and MEP did not change. NIVS with BiPAP did not cause any significant difference between groups. We conclude that noninvasive ventilatory support with bilevel positive airway pressure does not facilitate recovery from acute respiratory failure in patients with chronic obstructive pulmonary disease. Furthermore, a substantial proportion of patients (29%) do not tolerate noninvasive ventilatory support under these circumstances. From these results, we cannot recommend the use of noninvasive ventilatory support with bilevel positive airway pressure in the routine management of chronic obstructive pulmonary disease patients recovering from acute respiratory failure.