AECOPD呼吸衰竭患者无创正压通气治疗效果的相关因素分析

目的 探讨应用无创正压通气(noninvasive positive pressure ventilation,NIPPV)救治慢性阻塞性肺疾病急性加重(acute exacerbations of chronic obstructive pulmonary disease,AECOPD)并Ⅱ型呼吸衰竭失败的相关因素.方法 选取176例AECOPD并Ⅱ型呼吸衰竭的患者接受无创双水平气道内正压呼吸机治疗.按照治疗效果分为成功组和失败组,比较两组患者各项指标及变化,进行Logistic回归分析,寻找无创通气失败的相关因素.结果 NIPPV失败组患者稳定期FEV1%预计值较高,PaCO2值较低,治疗之前GCS评分较低,白蛋白及体质量指数较低,急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)较高,与NIPPV成功组比较差异有显著性意义.Logistic回归分析提示,治疗前格拉斯哥昏迷评分(GCS)及APACHE Ⅱ评分对NIPPV后期失败有显著影响.结论 治疗前GCS评分、APACHEⅡ评分是NIPPV治疗AECOPD并Ⅱ型呼吸衰竭失败的相关因素.

Analysis on relevant factors of the result of noninvasive positive pressure ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease and respiratory failure

Objective To investigate the factors related to the failure of noninvasive positive pressure ventilation(NIPPV) in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and typeⅡ respiratory failure. Methods One hundred and seventy six AECOPD patients with hypercapnia respiratory failure treated by BiPAP ventilation were enrolled and were divided into effective group and failure group according to the curative effect ,clinical and physiological parameters were analyzed comparatively between two groups, multi-variable logistic regression analysis was used to find the predictive factors of the failure in noninvasive ventilation. Results In stable phase, FEV1%predicted was higher,PaCO2 values was lower significantly in patients in NIPPV failure group who also had a lower GCS, lower albumin and BMI, higher APACHE Ⅱ on admission compared with NIPPV success group. Multi-variable logistic analysis suggests statistical significance in GCS and APACHE Ⅱ on admission. Conclusions The failure of NIPPV in patients with AECOPD and type Ⅱ respiratory faliure was influenced by GCS and APACHEⅡ on admission.