无创正压通气治疗呼吸衰竭临床研究年度进展2022  

Clinical update in non-invasive positive pressure ventilation for respiratory failure in 2022

作　　者：查姗姗 何振锋[1] 关力理 牛建一 黄巧云 陈荣昌 Zha Shanshan;He Zhenfeng;Guan Lili;Niu Jianyi;Huang Qiaoyun;Chen Rongchang(The First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory Health,State Key Laboratory of Respiratory Disease,National Clinical Research Center for Respiratory Disease,Guangzhou 510120,China;First Affiliated Hospital of Southern University of Science and Technology,Second Clinical Medical College of Jinan University,Shenzhen People′s Hospital,Shenzhen Institute of Respiratory Diseases,Shenzhen 518020,China)

机构地区：[1]广州医科大学附属第一医院、广州呼吸健康研究院、呼吸疾病国家重点实验室/国家呼吸系统疾病临床医学研究中心,广州510120 [2]南方科技大学第一附属医院、暨南大学第二临床医学院、深圳市人民医院呼吸与危重症医学科、深圳市呼吸疾病研究所,深圳518020

出　　处：《中华结核和呼吸杂志》2023年第1期77-81,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家重点研发计划(2017YFC1310600,2017YFC1310601);深圳市科技计划项目(KCXFZ202002011008256)。

摘　　要：本文通过Medline检索2021-10-01至2022-09-30期间无创正压通气(NPPV)用于治疗呼吸衰竭患者的相关临床研究文献并进行综述。在NPPV和高流量鼻导管氧疗(HFNC)治疗新型冠状病毒肺炎相关急性呼吸衰竭(ARF)中有3个大型随机对照试验,结果显示,NPPV(包括单水平持续气道正压通气和双水平气道内正压)可以降低气管插管率,HFNC的效果存在争论。此外,在NPPV治疗ARF的结局预测模型、NPPV相关的心搏骤停事件和人机界面对NPPV治疗效果的影响等方面也取得了一定进展。NPPV在气管插管前预氧合和辅助撤机拔管的研究中显示,NPPV可以减少气管插管过程中严重低氧血症的发生;有助于减少拔管后再次气管插管的风险。在长期家庭应用NPPV方面,提出成功启动的5个指标,但临床实践中符合5个指标的比例低,以及心理干预对长期NPPV依从性的影响等,这些研究结果有助于临床上合理选择和优化应用NPPV。In this article,we searched the research literatures related to clinical investigation of non-invasive positive pressure ventilation(NPPV)in acute respiratory failure(ARF)/chronic respiratory failure(CRF)between 1st October 2021 and 30th September 2022 through Medline,and reviewed the important advances.Three prospective randomized controlled studies related to the efficacy and safety of NPPV and/or high-flow nasal cannula oxygen therapy(HFNC)on patients with COVID-19 with ARF were reported,showing that NPPV(including continuous positive airway pressure and bilevel positive airway pressure)was able to reduce the intubation rate,but the efficacy of HFNC was contradictory.In addition,progress has been made in outcome prediction models for ARF treated with NPPV,NPPV-related cardiac arrest,and the impact of human-machine interface on NPPV treatment outcomes.The effects of NPPV as preoxygenation method before intubation was reported to be able to reduce severe desaturation during intubation,especially in obese population.The use of NPPV in extubated patients resulting in reduced reintubation rate was also studied.With regard to long-term home application of NPPV,five indicators of successful initiation were proposed,but the success rate was low in clinical practice.Some reports showed that psychological support could improve the adherence to NPPV.The results of these studies contributed to the rational selection and optimal application of NPPV in clinical practice.

关 键 词：严重低氧血症 持续气道正压通气 心搏骤停 呼吸衰竭 NPPV 气管插管 无创正压通气 临床实践 

分 类 号：R563.8[医药卫生—呼吸系统]