无创正压机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭失败的预测因素分析

目的分析应用无创正压机械通气（NIPPV）治疗慢性阻塞性肺疾病（COPD）合并呼吸衰竭失败的相关因素，为NIPPV的临床应用提供预测指标。方法将NIPPV治疗的236例COPD呼吸衰竭患者分为成功组、早期失败组和晚期失败组，监测患者生命体征指标和通气前、通气2h后血气分析及呼出气潮气量（ETV）指标，其他预测指标分析包括：患者年龄、性别、基础疾病严重程度和患者早期通气依从性、应用面罩耐受性、上机后开始床旁监测、护理时间。基础疾病严重程度采用急性生理与慢性健康状况评分（APACHEⅡ），意识障碍程度采用Glasgow昏迷指数（GCS），患者营养状况采用血清白蛋白（Alb）浓度表示。结果NIPPV治疗COPD合并呼吸衰竭成功率为72．0％。早期失败40例、晚期失败26例，总失败率为28．O％。在早期通气依从性、对面罩耐受性方面成功组均明显好于早、晚期失败组；初次使用呼吸机监测、护理时间，早、晚期失败组均低于成功组；在APACHEⅡ评分中早、晚期失败组明显高于成功组；在GCS、Alb方面成功组明显高于早、晚期失败组，通气前早、晚期失败组患者pH值明显低于成功组，呼吸频率（RR）明显高于成功组，而PaO2、PaCO2、ETV在通气前三组之间没有显著差异。与早期失败组不同，在通气2h后成功组，晚期失败组pH、PaO2、PaCO2、ETV较通气前明显改善。结论NIPPV虽已成为COPD呼吸衰竭的一线治疗方法，但正确判断疾病的严重程度、评估治疗前后的病情变化、预测NIPPV成功指标和危险因素，对临床合理应用NIPPV尤为重要。

Forecasting elements analysis of the failure treatment through non-invasive positive pressure ventilation on COPD patients with respiratory failure

Objective To analyze the related factors of the failure treatment through non-invasive positive pressure ventilation （NIPPV） on chronic obstructive pulmonary diseasec （COPD） patients with respiratory failure and provide the forecasting elements of NIPPV for physicians. Methods 236 patients with respiratory failure treated by NIPPV were divided into success group, early failure group and advanced failure group. To monitor and analyze the patients＇ vital signs, the blood-gas analysis and expired tidal volume （ETV） before and 2-hours after ventilation; other forecasting factors included ： age, sex, severity of basic diseases, patients early ventilation compliance, mask-using tolerance. The severity of basic diseases were evaluated by acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ）, the degree of conscious disturbance were evaluated by Glasgow coma scale（GCS）, the nutritional status assessment was evaluated through serum albumin CA （b） concentration. Results The success rate of NIPPV treatment on patients with respiratory failure was 72.0%. 40 cases were early failed, 26 cases were failed at late stage, and the total failure rate was 28.0%. The success group was better significantly than the early failure and advanced failure groups on the patients＇ early ventilation compliance, mask-using tolerance. The early failure and advanced failure groups were shorter than the success group at the time of first-time ventilatorused nursing. The early failure and advanced failure groups were higher than the success group at the APACHE Ⅱ. The success group was higher than the other two groups at the GCS, Alb. Compared with the success group, the early failure and advanced failure groups＇ PH before ventilation were lower, the RR were quicker. The PaO2, PaCO2, ETV before ventilation were not significantly different in three groups. Different from the early failure group, the other two groups＇ pH, PaO2, PaCO2, ETV were better significantly after 2 hours ventilation. Conclusion NIPPV has become the first line treatment to the COPD patients with respiratory failure, but it is very important to use NIPPV rationally in clinical practice on the basic of disease severity judgment, the severity change evaluation during treatment, the success and failure factors＇ forecasting.