三种简易量表对慢性阻塞性肺疾病急性加重伴Ⅱ型呼吸衰竭患者病情的评估价值

目的探讨BAP-65、DECAF、CAPS三种量表对慢性阻塞性肺疾病（简称慢阻肺）急性加重伴Ⅱ型呼吸衰竭住院患者病情的评估价值。方法采集244例慢阻肺急性加重伴Ⅱ型呼吸衰竭患者入院时的基本资料及生理参数,进行回顾性分析,分别计算BAP-65、DECAF、CAPS评分,利用SPSS软件分析每种量表评估死亡率、机械通气率、机械通气组死亡率及有创通气率的ROC曲线下面积（AUROC）并比较。结果 BAP-65、DECAF、CAPS量表评估慢阻肺急性加重伴Ⅱ型呼吸衰竭住院患者死亡率的AUROC分别为0.731、0.765、0.711,评估机械通气的AUROC分别为0.638、0.702、0.617,评估机械通气组死亡率的AUROC分别为0.672、0.707、0.677,评估机械通气组采用有创通气方式的AUROC分别为0.745、0.732、0.627（BAP-65和CAPS评分比较,P〈0.05）。BAP-65或DECAF评分在4分以上的患者中,死亡率约为50%,需要机械通气支持的占95%以上。结论入院时BAP-65、DECAF、CAPS评分对于评估慢阻肺急性加重伴Ⅱ型呼吸衰竭患者的住院死亡率、机械通气率、机械通气患者的死亡率及有创通气率有一定价值,其中BAP-65、DECAF量表更加简洁实用。

The Value of Three Brief Scales to Assess the Severity of Acute Exacerbation in Patients with COPD Complicated by Hypercapnic Respiratory Failure

Objective To explore the value of three brief scales（ BAP-65 class,DECAF score,and CAPS） on assessing the severity of acute exacerbation in patients with chronic obstructive pulmonary disease（ COPD） complicated by hypercapnic respiratory failure. Methods Two hundred and forty-four cases with acute exacerbation of COPD complicated by hypercapnic respiratory failure,admitted in West China Hospital from August 2012 to December 2013,were analyzed retrospectively. The scores of each scale were calculated.The areas under the receiver operating characteristic curves（ AUROC） of each scale for hospital mortality,mechanical ventilation use,mortality of patients requiring mechanical ventilation,invasive mechanical use were analyzed and compared. Results The AUROCs of BAP-65 class,DECAF score and CAPS for hospital mortality were 0. 731,0. 765,and 0. 711; for mechanical ventilation were 0. 638,0. 702,and 0. 617; for mortality of patients requiring mechanical ventilation were 0. 672,0. 707,and 0. 677; for invasive mechanical ventilation use were 0. 745,0. 732,and 0. 627（ BAP-65 vs. CAPS,P 〈 0. 05）. Mortality and mechanical ventilation use increased as the three scales escalated. In the patients whose BAP-65 or DECAF score were more than 4 points,the hospital mortality was nearly 50%,and about 95% of the patients underwent mechanical ventilation. Conclusions The BAP-65 class,DECAF score,and CAPS of patients on admission have predictive values on assessing the severity of acute exacerbation in patients with COPD complicated by hypercapnic respiratory failure,especially the simple and practical BAP-65 class and DECAF score.