急诊无创正压通气治疗慢性阻塞性肺疾病急性加重失败因素分析

目的:分析在急诊应用无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重(AECOPD)失败的因素。方法:45例AECOPD患者给予无创正压通气,通气模式采用压力支持通气(PSV)加呼气末正压通气(PEEP),根据是否需要气管插管分为NPPV成功组和NPPV失败组。比较两组治疗前和治疗后1 h动脉血气、呼吸频率、呼吸困难指数(DS)以及氧合指数(PaO2/FiO2)。结果:治疗1 h后NPPV失败组呼吸频率、DS高于NPPV成功组,而动脉血pH较NPPV成功组低。无创通气失败的独立危险因素有1 h后呼吸频率>20次/min(OR=4.55,95%CI=1.22-16.97),1 h后DS≥5分(OR=9.36,95%CI=2.1-42.8),以及1 h后pH<7.35(OR=10.7,95%CI=1.25-91.6)。结论:急诊NPPV治疗AECOPD后1 h呼吸频率>20次/min、DS≥5分以及pH<7.35则提示NPPV失败的高度可能。

Analysis on Failure Factors for Noninvasive Positive Pressure Ventilation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Emergency Department

Objective: To investigate the factors associated with failure of noninvasive positive pressure ventilation(NPPV) in patients presenting with acute exacerbation of COPD(AECOPD) in emergency department.Methods: Forty-five patients admitted to the emergency department with AECOPD for NPPV treatment were retrospectively analyzed.The mode of ventilation is PSV plus PEEP.The patients were divided into NPPV success group and NPPV failure group.The changes of the arterial blood gas,respiratory rate,dyspnea scores(DS),and oxygenation indexes(PaO2/FiO2) were compared before and after 1-hour NPPV between the two groups.Results: Respiratory rate and DS were higher in NPPV failure group,but pH was higher in NPPV success group.Factors associated with failure of NPPV were respiratory rate >20 beats/min(OR=4.55,95%CI=1.22-16.97),DS≥5(OR=9.36,95%CI=2.1-42.8),and pH<7.35(OR=10.7,95%CI=1.25-91.6) after one hour NPPV.Conclusion: Patients with RR>20 beats/min,DS≥5,and pH<7.35 had an increased risk of endotracheal intubation after one hour of NPPV.