慢性慢性肺炎患者的长期非侵入性通风在急性气性呼吸衰竭恶化后:一项随机对照试验
Caroline Hedsund1, Kasper Linde Ankjærgaard1, Tine Peick Sonne1
1Respiratory Medicine Unit, Department of Internal Medicine, Copenhagen University Hospital - Herlev-Gentofte Hospital, Hellerup, Denmark.
长期非侵入性通风 (LT-NIV) 对于慢性阻塞性肺病 (COPD) 患者在急性超呼吸衰竭 (AHRF) 后没有显著改善生存率,但减少了AHRF入院和恶化. 高压LT-NIV在治疗COPD恶化方面表现有前途.
科学领域:
- 肺部医学 肺部医学
- 呼吸系统护理 呼吸系统护理
- 临床试验 临床试验
背景情况:
- 慢性阻塞性肺病 (COPD) 管理仍然具有挑战性,长期非侵入性通风 (LT-NIV) 益处的证据不一致.
- 急性超气呼吸衰竭 (AHRF) 是一种需要干预的常见并发症.
研究的目的:
- 评估在AHRF后启动的LT-NIV对COPD患者的生存率和住院率的影响.
- 评估高压LT-NIV在减少AHRF事件和恶化中的有效性.
主要方法:
- 一个随机控制的开放标签试验,将LT-NIV与AHRF后COPD患者的标准护理进行比较.
- LT-NIV旨在使用高压设置将PaCO2正常化.
主要成果:
- 主要结局 (AHRF再入院时间或12个月内死亡) 没有达到统计学意义 (HR0.53,p=0.097).
- 然而,LT-NIV显著降低了12个月的AHRF风险 (OR 0.30,p=0.024),恶化 (中位数为1比2,p=0.021) 和AHRF再入院 (中位数为0比1,p=0.016).
- 在有往往频繁入院的患者中,益处更为明显.
结论:
- 虽然LT-NIV在12个月内没有显著改善生存的复合初级结果或减少AHRF的再入院,但它在二次结果中显示出显著的好处.
- 高压LT-NIV有效降低了AHRF,恶化和AHRF相关再入院的发生率,特别是在有频繁AHRF病史的患者中.
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