无创正压通气治疗慢性阻塞性肺疾病急性加重合并呼吸衰竭失败的相关因素分析

目的 探讨应用无创正压通气(noninvasive positive pressure ventilation,NPPV)治疗慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD) 合并呼吸衰竭失败的相关因素,为临床合理使用NPPV提供依据.方法 回顾性分析NPPV治疗的AECOPD并Ⅱ型呼吸衰竭患者85例,按治疗转归分为NPPV治疗成功组和NPPV治疗失败组.比较治疗前两组患者临床生理生化指标、动脉血气、APACHEⅡ评分和格拉斯哥昏迷评分(Glasgow coma scale,GCS),以及治疗过程中NPPV并发症的发生情况和治疗2 h后的动脉血气(pH、PaCO2)的变化情况.结果 ①失败组治疗前的APACHEⅡ评分、C反应蛋白水平以及治疗过程中NPPV并发症的发生率明显高于成功组,而GCS评分明显低于成功组(均P＜0.05).其余指标两组间比较均无统计学差异.②两组患者NPPV治疗前血气指标比较无显著性差异.通气治疗2 h后,成功组的动脉血pH值明显高于失败组,而PaCO2明显低于失败组,差异均有统计学意义(P＜0.05).成功组治疗前和治疗2 h后的血气指标比较差异有统计学意义(P＜0.05),而失败组治疗前和治疗2 h后血气指标比较差异无统计学意义.结论 高APACHEⅡ评分、低GCS评分、治疗2 h后动脉血气改善不佳和治疗过程中出现NPPV的并发症是AECOPD患者NPPV治疗失败的相关危险因素.具有上述危险因素的AECOPD患者NPPV治疗失败的可能性较大,应尽早考虑有创机械通气.

Analysis of factors associated with failure of noninvasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

Objective To explore the related factors of noninvasive positive pressure ventilation(NPPV)failure for acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure.Methods The clinical data of 85 AECOPD patients presenting with type Ⅱ respiratory failure were analyzed retrospectively.According to the curative effect of NPPV,patients were divided into success group and failure group.The physiological and biochemical indicators,acute physiology assessment and chronic health evaluation(APACHE)Ⅱ score and Glasgow coma scale(GCS)on admission were compared,and frequency of complications of NPPV,the changes of the arterial blood after NPPV for 2 h were also analyzed comparatively.Results ①In failure group,the pretreatment APACHE Ⅱ score,serum C-reactive protein level on admission and frequency of complications of NPPV were significantly higher and GCS was significantly lower than those in success group(P<0.05).②Before NPPV treatment,there was no significant difference in pH and PaCO2 between two groups(P>0.05).In success group,pH was significantly higher after NPPV for 2 h and PaCO2 was significantly lower than those in failure group(P<0.05).There was an significant increase of pH and a decrease of PaCO2 in success group on admission and after NPPV for 2 h(P<0.05),while there was no significant changes in failure group(P>0.05).Conclusion High APACHE Ⅱ score and low GCS,presence of complications of NPPV and no improvement in pH and PaCO2 after 2 h of NPPV are risk factors associated with NPPV failure.Patients with these risk factors should be considered a need of early invasive ventilation.