重度哮喘急性加重期间无创正压通气使用与临床结局的相关性：基于倾向评分匹配的队列研究
2026/01/28
目的：目前支持在重度哮喘急性加重期间应用无创正压通气（NPPV）的循证证据依然有限。本研究旨在分析因哮喘急性加重住院患者的NPPV使用率、气管插管率与住院死亡率的年度变化趋势，并评估NPPV使用与后续气管插管及住院死亡率之间的关联。
研究设计：一项回顾性、基于倾向评分匹配的队列研究。
数据来源：2006年至2019年纽约和佛罗里达州的医疗保健成本与利用项目（Healthcare Cost and Utilization Project，HCUP）住院数据库。
研究对象：因哮喘急性发作住院的5-80岁患者。
干预：接受无创正压通气（NPPV）治疗。
测量和主要结果：在2006-2018年期间共纳入296,788例因哮喘急性加重住院病例中，其中，成人患者中NPPV使用率从1.2%上升至7.4%（绝对差异6.1%；95% CI，5.6–6.7%）；儿科患者的NPPV使用率从0.7%上升至7.1%（绝对差异6.4%；95% CI，5.5–7.3%）。在41,902例ICU住院病例中，我们采用倾向评分匹配方法，将1,972名接受NPPV的成人患者与6,510名未接受NPPV的成人患者进行匹配，并将1,622名接受 NPPV 的儿科患者与4,766名未接受NPPV的儿科患者进行匹配。结果显示，在成人患者中，NPPV的使用与后续插管的风险降低（相对危险度[RR]，0.48；95% CI，0.40-0.57）及住院死亡率下降（相对危险度[RR]，0.33； 95%CI，0.21-0.54）显著相关。在儿科患者中，NPPV的使用与气管插管风险降低相关（相对危险度[RR]，0.50； 95%CI，0.29-0.89），但对住院死亡率的改善未达到统计学显著性（相对危险度[RR]，0.41； 95%CI，0.15-1.11）。
结论：哮喘急性加重患者中NPPV的应用比例呈持续上升趋势。在成人及儿科患者中，NPPV的使用均与气管插管风险降低相关。此外，在成人患者中，NPPV的使用还与住院死亡率降低相关。
关键词：哮喘；哮喘加重；重症监护；无创通气。
Objective: The evidence supporting the use of noninvasive positive pressure ventilation (NPPV) during severe asthma exacerbations is limited. We determined the annual trend in NPPV use, endotracheal intubations, and in-hospital mortality among all hospitalizations for an asthma exacerbation. We additionally evaluated the association between NPPV use and subsequent endotracheal intubation and in-hospital mortality.
Design: Retrospective, propensity-score–matched cohort study.
Setting: Administrative data from Healthcare Cost and Utilization Project’s State Inpatient Databases for New York and Florida, 2006–2019.
Patients: Patients 5–80 years old hospitalized with an asthma exacerbation.
Interventions: Receipt of NPPV.
Measurements and main results: Among 296,788 hospitalizations for an asthma exacerbation between 2006 and 2018, NPPV use for an asthma exacerbation increased from 1.2% to 7.4% (absolute difference, 6.1%; 95% CI, 5.6–6.7%) in adults and from 0.7% to 7.1% (absolute difference, 6.4%; 95% CI, 5.5–7.3%) in pediatric patients. Among 41,902 ICU encounters, we propensityscore matched 1,972 adult and 1,622 pediatric patients who received NPPV with 6,510 adults and 4,766 pediatric patients who did not receive NPPV. NPPV use was associated with a decreased risk of subsequent intubation (risk ratio [RR], 0.48; 95% CI, 0.40–0.57) and improved in-hospital mortality (RR, 0.33; 95% CI, 0.21–0.54) in adults. In pediatric patients, use of NPPV was associated with a decreased risk of intubation (RR, 0.50; 95%CI,0.29–0.89), but not significant for an improvement in in-hospital mortality (RR, 0.41; 95% CI, 0.15–1.11).
Conclusions: NPPV use for asthma exacerbations has increased. In adult and pediatric patients, NPPV use for an asthma exacerbation was associated with a decreased risk of endotracheal intubation. Furthermore, NPPV use for an asthma exacerbation was associated with improved in-hospital mortality in adult patients.
Keywords: asthma; asthma exacerbation; critical care; intensive care; noninvasive ventilation.
研究设计：一项回顾性、基于倾向评分匹配的队列研究。
数据来源：2006年至2019年纽约和佛罗里达州的医疗保健成本与利用项目（Healthcare Cost and Utilization Project，HCUP）住院数据库。
研究对象：因哮喘急性发作住院的5-80岁患者。
干预：接受无创正压通气（NPPV）治疗。
测量和主要结果：在2006-2018年期间共纳入296,788例因哮喘急性加重住院病例中，其中，成人患者中NPPV使用率从1.2%上升至7.4%（绝对差异6.1%；95% CI，5.6–6.7%）；儿科患者的NPPV使用率从0.7%上升至7.1%（绝对差异6.4%；95% CI，5.5–7.3%）。在41,902例ICU住院病例中，我们采用倾向评分匹配方法，将1,972名接受NPPV的成人患者与6,510名未接受NPPV的成人患者进行匹配，并将1,622名接受 NPPV 的儿科患者与4,766名未接受NPPV的儿科患者进行匹配。结果显示，在成人患者中，NPPV的使用与后续插管的风险降低（相对危险度[RR]，0.48；95% CI，0.40-0.57）及住院死亡率下降（相对危险度[RR]，0.33； 95%CI，0.21-0.54）显著相关。在儿科患者中，NPPV的使用与气管插管风险降低相关（相对危险度[RR]，0.50； 95%CI，0.29-0.89），但对住院死亡率的改善未达到统计学显著性（相对危险度[RR]，0.41； 95%CI，0.15-1.11）。
结论：哮喘急性加重患者中NPPV的应用比例呈持续上升趋势。在成人及儿科患者中，NPPV的使用均与气管插管风险降低相关。此外，在成人患者中，NPPV的使用还与住院死亡率降低相关。
关键词：哮喘；哮喘加重；重症监护；无创通气。
（南方医科大学南方医院 钟梓同 樊可可 赵海金）
(Abbott,Matthew R.MD,et, al. Association Between Noninvasive Positive Pressure Ventilation Use and Clinical Outcomes During a Severe. Asthma Exacerbation:A Cohort Study. Critical Care Medicine:10.1097/CCM.0000000000007025, January 14, 2026. |DOI: 10.1097/CCM.0000000000007025)
Abstract(Abbott,Matthew R.MD,et, al. Association Between Noninvasive Positive Pressure Ventilation Use and Clinical Outcomes During a Severe. Asthma Exacerbation:A Cohort Study. Critical Care Medicine:10.1097/CCM.0000000000007025, January 14, 2026. |DOI: 10.1097/CCM.0000000000007025)
Objective: The evidence supporting the use of noninvasive positive pressure ventilation (NPPV) during severe asthma exacerbations is limited. We determined the annual trend in NPPV use, endotracheal intubations, and in-hospital mortality among all hospitalizations for an asthma exacerbation. We additionally evaluated the association between NPPV use and subsequent endotracheal intubation and in-hospital mortality.
Design: Retrospective, propensity-score–matched cohort study.
Setting: Administrative data from Healthcare Cost and Utilization Project’s State Inpatient Databases for New York and Florida, 2006–2019.
Patients: Patients 5–80 years old hospitalized with an asthma exacerbation.
Interventions: Receipt of NPPV.
Measurements and main results: Among 296,788 hospitalizations for an asthma exacerbation between 2006 and 2018, NPPV use for an asthma exacerbation increased from 1.2% to 7.4% (absolute difference, 6.1%; 95% CI, 5.6–6.7%) in adults and from 0.7% to 7.1% (absolute difference, 6.4%; 95% CI, 5.5–7.3%) in pediatric patients. Among 41,902 ICU encounters, we propensityscore matched 1,972 adult and 1,622 pediatric patients who received NPPV with 6,510 adults and 4,766 pediatric patients who did not receive NPPV. NPPV use was associated with a decreased risk of subsequent intubation (risk ratio [RR], 0.48; 95% CI, 0.40–0.57) and improved in-hospital mortality (RR, 0.33; 95% CI, 0.21–0.54) in adults. In pediatric patients, use of NPPV was associated with a decreased risk of intubation (RR, 0.50; 95%CI,0.29–0.89), but not significant for an improvement in in-hospital mortality (RR, 0.41; 95% CI, 0.15–1.11).
Conclusions: NPPV use for asthma exacerbations has increased. In adult and pediatric patients, NPPV use for an asthma exacerbation was associated with a decreased risk of endotracheal intubation. Furthermore, NPPV use for an asthma exacerbation was associated with improved in-hospital mortality in adult patients.
Keywords: asthma; asthma exacerbation; critical care; intensive care; noninvasive ventilation.
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