NIPV治疗重症肺炎患者凝血功能及预后的影响因素分析

目的 分析行无创正压通气(noninvasive positive pressure ventilation, NIPV)治疗的重症肺炎(severe pneumonia, SP)患者凝血功能与预后的关系及影响因素。方法 选择2017年1月至2021年12月因SP入住江苏省苏北人民医院重症监护病房并接受NIPV治疗的患者51例。根据患者凝血功能异常程度分为观察组24例，对照组27例，比较两组凝血功能及预后相关指标；分析影响预后的危险因素。结果 观察组APTT、PT、INR、D-二聚体明显高于对照组；观察组患者气管插管比例明显高于对照组，且NIPV持续时间及ICU住院时间均明显长于对照组(P<0.05)。单因素分析结果提示，预后不良患者入院时APACHEⅡ评分、入院后48 h PT、APTT、INR、乳酸水平明显升高；患者入院时呼吸频率、心率、pH、PaCO₂>60 mmHg比例以及NIPV开始时pH、PaO₂、FiO₂、PaO₂/FiO₂与患者的不良预后关系密切(P...

Analysis of influencing factors of coagulation function and prognosis of severe pneumonia patients undergoing non-invasive positive pressure ventilation

ObjectiveTo analyze the relationship between coagulation function and prognosis of severe pneumonia patients treated with noninvasive positive pressure ventilation (NIPV) and its influencing factors. MethodsA total of 51 patients with severe pneumonia admitted to the intensive care unit of North Jiangsu People's Hospital from January 2017 to December 2021 and all patients were treated with NIPV. The patients were divided into observation group and control group according to the degree of abnormal coagulation function, and the indexes related to coagulation function and prognosis were detected and compared between these two groups. The respiratory rate, blood pressure, partial oxygen pressure, oxygenation index, lactic acid level and other related indicators of patients before and after non-invasive positive pressure ventilation were compared based on the prognosis of patients, and then the prognostic risk indicators were analyzed. Result24 of the 51 patients (47.06%) with severe pneumonia had obvious coagulation dysfunction at admission. APTT, PT, INR and D-dimer in the observation group were significantly higher than those in the control group. Compared with the control group, the proportion of tracheal intubation in the observation group was significantly higher than that in the control group, and the duration of NIPV and ICU stay were significantly longer than that in the control group (P<0.05). Univariate analysis indicated that APACHE-Ⅱ scores at admission and PT, APTT, INR and lactic acid levels at 48 hours after admission were significantly increased in the poor prognosis group. In addition, respiratory rate, heart rate, blood pH at admission, proportion of PaCO₂>60 mmHg, blood pH, PaO₂, FiO₂, PaO₂/FiO₂ at the beginning of NIPV treatment were also closely related to poor prognosis, and the differences were statistically significant. ConclusionThere are obvious abnormal coagulation dysfunction in patients with severe pneumonia, which is closely related to prognosis. Multiple factors can influence the outcome of patients with severe pneumonia treated with NIPV. In order to improve the prognosis of patients with severe pneumonia, it is necessary to pay attention to and dynamically evaluate the coagulation function of patients when NIPV treatment is performed.