无创正压机械通气治疗呼吸衰竭失败的原因分析

目的分析无创正压机械通气（NIPPV）常见的失败原因，探求失败的相关因素，为NIPPV的临床应用提供可能的预警因素。方法回顾性调查2001年1月～2007年1月我院呼吸科收治进行NIPPV治疗的患者350例，按通气后疗效及转归分为成功组（292例）和失败组（58例）。两组按动脉血二氧化碳分压（PaCO2）值分为Ⅰ型呼吸衰竭（PaCO2〈50mmHg，1mmHg=0．133kPa）和Ⅱ型呼吸衰竭（PaCO2≥50mmHg）。分别记录并比较各组患者的基础病变、入院时和通气失败时血气分析以及NIPPV影响因素。结果NIPPV治疗各种类型呼吸衰竭的总有效率为83．4％，其中Ⅱ型呼吸衰竭的有效率达92．3％，明显高于≥型呼吸衰竭的52．6％（P〈0．01）。慢性阻塞性肺疾病（COPD）NIPPV治疗成功率为92．6％，明显高于肺癌27．3％（P〈0．01）。失败组患者痰液窒息、呕吐物误吸、胃肠胀气和面罩漏气的发生率分别为44．0％、16．0％、44．0％和20．0％，均高于成功组的0、0、9．8％和0（P均〈0．01）。结论NIPPV在抢救多种原因引起的呼吸衰竭有重要的临床价值，呼吸衰竭的类型、基础疾病会影响NIPPV的疗效，而痰液窒息、呕吐物误吸、面罩漏气、胃肠胀气和昏迷是直接导致NIPPVV失败的常见原因。

A retrospective analysis on common causes of failure of noninvasive positive pressure ventilation in patients with respiratory failure

Aim To analyze the common causes of failure of noninvasive positive pressure ventilation （NIPPV）. Methods 350 patients with respiratory failure treated by NIPPV were divided into successful group（SG） and failure group（FG） according to effectiveness and prognosis of NIPPV. 292 cases of SG and 58 cases of FG were respectively divided into type Ⅰ respiratory failure group（ PaCO2 〈50 mmHg, 1 mmHg = 0. 133 kPa） and type ⅠⅡ respiratory failure group（ PaCO2 〉 50 mmHg）. The primary disease, results of blood gas analysis on admission and failing NIPPV were recorded. The risk factors leading to NIPPV failure were registered and analyzed. Results The total efficacy of NIPPV was 83.4%. The efficacy of NIPPV for type Ⅱ respiratory failure was 92.3% which was significantly higher than that of type I respiratory failure（52.6% , P 〈 0.01 ）. The efficacy of NIPPV for COPD （92.6%）was significantly higher than that of lung cancer（ 27.3% ）, （ P 〈 0.01 ）. The incidence rates of sputum asphyxia, vomit aspiration, flatulence and serious leakage of face mask in FG were 44.0% ,16.0% ,44.0% and 20. 0% respectively,which were significantly higher than those in SG（0,0,9.8% and 0 respectively, P 〈 0.01 ）. Conclusion This study showed that NIPPV played key role in respiratory failure. The primary disease, results of blood gas were the main risk factors influencing the prognosis. Sputum asphyxia, vomit aspiration, flatulence and serious leakage of face-mask are common causes leading to failure of NIPPV directly.