本综述通过Medline检索2023年10月1日至2024年9月30日期间无创正压通气(NPPV)相关临床研究的文献,系统梳理了2024年度NPPV在急性呼吸衰竭(ARF)和慢性呼吸衰竭(CRF)中应用的最新研究进展。在NPPV治疗ARF方面,通过数字孪生体实验发现过高潮气量相关的自发式肺损伤可能是导致NPPV失败的原因;NPPV期间镇静镇痛剂的使用与病死率增加相关。在慢性阻塞性肺疾病急性加重患者治疗方面,高强度NPPV可显著降低插管率;而高流量鼻导管氧疗作为初始治疗疗效劣于NPPV。在CRF患者家庭NPPV治疗方面,基于法国国家医疗保健系统数据库探索了接受家庭NPPV治疗的慢性阻塞性肺疾病患者的在启动NPPV之前的健康轨迹,提出不同情况下启动家庭NPPV治疗对预后发生影响;国内研究发现,基于物联网对家庭NPPV进行远程管理可进一步改善患者的生活质量及降低再入院风险。预防再插管方面,不同基础疾病对NPPV治疗反应不相同,预防性应用NPPV可降低肥胖患者术后、而非急性脑损伤患者的再插管风险。在NPPV技术改进方面,有学者联合储氧袋和中流量氧疗制作出简易的Bag-CPAP,可作为资源紧缺时备选通气选择。
The present review conducted a comprehensive search and retrieval of clinical studies related to non-invasive positive pressure ventilation (NPPV) for acute respiratory failure (ARF) and chronic respiratory failure (CRF) retrieved from Medline between October 1, 2023 and September 30, 2024. In the treatment of ARF with NPPV, experiments using Digital Twins had shown that excessive tidal volumes associated self-inflicted lung injury might contribute to NPPV failure. The administration of sedation and analgesia during NPPV was found to correlate with increased mortality. In patients with acute exacerbations of chronic obstructive pulmonary disease, high-intensity NPPV significantly reduced intubation rates. However, high-flow nasal cannula oxygen therapy (HFNC) was less effective than NPPV when used as an initial treatment. In the management of CRF patients, a Franch study examined the pre-NPPV health trajectory of COPD patients receiving home NPPV based on French national health insurance reimbursement system database and suggested that the timing of initiation of home NPPV treatment significantly influenced prognosis. In addition, the research found that remote management utilizing Internet of Things technology enhanced patients′ health-related quality of life and reduced the risk of hospital readmission. In terms of preventing re-intubation, different underlying conditions exhibited different responses to NPPV treatment. Specifically, prophylactic use of NPPV was found to reduce the risk of reintubation in obese surgical patients, but not in those with acute brain injury. In terms of technological advancements, Bag-CPAP, a device consisting of an oxygen storage bag and medium flow oxygen, has been validated as an alternative ventilation choice suitable for resource-limited settings.
黄巧云,查姗姗,关力理,等. 无创正压通气临床研究年度进展2024[J]. 中华结核和呼吸杂志,2025,48(02):154-158.
DOI:10.3760/cma.j.cn112147-20241118-00683版权归中华医学会所有。
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