Chest：体外CO₂清除装置可治疗高碳酸血症性呼吸衰竭的COPD患者

伴高碳酸血症的COPD患者常规应用机械通气治疗，但体外CO₂清除装置治疗这种患者仍无系统性评价研究。针对这种情况，来自美国康涅狄格大学健康中心的Burki博士等人进行了一项试验性研究，研究结果发表于2013年3月的《胸腔》(Chest)杂志上。作者发现体外CO₂清除装置可用于治疗高碳酸血症性呼吸衰竭的COPD患者。

研究人员对30名高碳酸血症的COPD患者行试验性治疗，并确定了无创通气治疗患者（n=7）、无创通气治疗且无法脱机患者（n=2）和有创通气治疗且无法脱机患者（n=11）。体外CO₂清除装置应用单腔静脉导管，对各组的血流量、动脉CO₂分压（Pa CO₂）及脱机情况进行比较。

结果显示，血流量及体外CO₂清除装置的血流量稳定（430.5±73.7 mL/min；82.5±15.6 mL/min）。无创通气治疗患者均不需有创通气治疗，且PaCO₂明显下降（78.9±16.8 mm Hg至65.9±11.5 mm Hg）;无创通气治疗且无法脱机患者及有创通气治疗且无法脱机患者均可脱机。

该研究发现，体外CO₂清除装置以单腔，低流量为特点，可降低高碳酸血症性呼吸衰竭的COPD患者的血CO₂浓度。该装置可作为治疗高碳酸血症性呼吸衰竭的COPD患者的一种辅助治疗方法。

A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD.
BACKGROUND
Hypercapnic respiratory failure in patients with COPD frequently requires mechanical ventilatory support. Extracorporeal CO2 removal (ECCO2R) techniques have not been systematically evaluated in these patients.
METHODS
This is a pilot study of a novel ECCO2R device that utilizes a single venous catheter with high CO2 removal rates at low blood flows. Twenty hypercapnic patients with COPD received ECCO2R. Group 1 (n = 7) consisted of patients receiving noninvasive ventilation with a high likelihood of requiring invasive ventilation, group 2 (n = 2) consisted of patients who could not be weaned from noninvasive ventilation, and group 3 (n = 11) consisted of patients on invasive ventilation who had failed attempts to wean.
RESULTS
The device was well tolerated, with complications and rates similar to those seen with central venous catheterization. Blood flow through the system was 430.5 ± 73.7 mL/min, and ECCO2R was 82.5 ± 15.6 mL/min and did not change significantly with time. Invasive ventilation was avoided in all patients in group 1 and both patients in group 2 were weaned; PaCO2 decreased significantly (P < .003) with application of the device from 78.9 ± 16.8 mm Hg to 65.9 ± 11.5 mm Hg. In group 3, three patients were weaned, while the level of invasive ventilatory support was reduced in three patients. One patient in group 3 died due to a retroperitoneal bleed following catheterization.
CONCLUSIONS
This single-catheter, low-flow ECCO2R system provided clinically useful levels of CO2 removal in these patients with COPD. The system appears to be a potentially valuable additional modality for the treatment of hypercapnic respiratory failure.