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作 者:王言森[1] 张敏[2] 王建平[2] 王少媛[1] 杜向阳[1] 孙先义[1]
机构地区:[1]山东省交通医院呼吸内科,济南250031 [2]山东省立医院呼吸内科,济南250031
出 处:《国际呼吸杂志》2007年第13期964-966,共3页International Journal of Respiration
摘 要:目的分析应用无创正压机械通气(NIPPV)治疗呼吸衰竭病例资料,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。方法经NIPPV治疗387例患者分为成功组和失败组,监测患者生命体征指标和血气分析指标,多因素分析包括患者年龄、受教育程度、呼吸衰竭的病程、患者的基础疾病和患者的依从性、上机后开始床旁监测时间、应用呼吸机早期病情的变化。基础疾病采用急性生理与慢性健康评分(APACHEⅡ),神志改变采用Glasaow昏迷评分(GCS)。结果在NIPPV早期依从性方面,失败组明显低于成功组,并且失败组初次使用呼吸机的监护时间明显低于成功组。在APACHEⅡ评分方面,失败组明显高于成功组。两组初始血气分析指标没有显著差别,但随着通气时间的延长,成功组明显好转,而失败组无明显变化,NIPPV在抢救多种原因引起的呼吸衰竭成功率为86.3%。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;失败组APACHEⅡ评分明显高于成功组,说明失败组病情危重,合并多器官功能不全,严重影响患者的预后;使用NIPPV的早期治疗反应非常重要。Objective To investigate the predictors of failure of noninvasive positive pressure ventilation(NIPPV) in the patients with respiratory failure. Methods 387 cases treated with NIPPV were divided into cure group and failure group. Arterial blood gas and vital signs were measured. The multiple factors included age, education, time course of respiratory failure, fundamental diseases, compliance, time point of bedside monitor, and the changes of syndromes during the early period with NIPPV. The fundamental diseases were scored by APACHEⅡ and consciousness conditions were estimated by GCS system. Results Compared with cure group, the patients in failure group presented obviously worse compliance and shorter monitor time with higher score of APACHE. There was no difference in arterial blood gas before NIPPV between two groups, however, the patients in cure group improved significantly along with NIPPV. The efficacy of NIPPV in the patients with respiratory failure due to various diseases was 86.3%. Conclusions This study showed that NIPPV played key role in respiratory failure. The patients in failure group with obvious higher APACHE score revealed that the patients in failure group presented severe disease states and multiple organ dysfunction, which in turn affected the outcome. The early reaction to NIPPV was important.
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