无创正压通气治疗免疫抑制合并急性呼吸衰竭患者的临床分析  

Clinical analysis of non-invasive positive pressure ventilation in immunocompromised host with acute respiratory failure

作　　者：张鑫[1] 王慧娟[1] 磨国鑫[1] 赵铁梅[1] 贾艳红[1] 解立新[1] 

机构地区：[1]解放军总医院呼吸科,北京100853

出　　处：《中国危重病急救医学》2011年第9期530-533,共4页Chinese Critical Care Medicine

基　　金：基金项目：国家“十一五”科技支撑计划（2009BAI86803）

摘　　要：目的探讨免疫抑制（ICH）合并急性呼吸衰竭（ARF）患者接受无创正压通气（NPPV）的疗效及影响NPPV成功的因素。方法选择2008年3月至2011年3月在本院呼吸重症监护病房（RICU）应用NPPV治疗的1CH合并ARF患者，记录其各项临床资料；采用单因素Logistic回归分析NPPV治疗成功的独立影响因素；按临床转归进行免疫状态评估。结果33例ICH合并ARF患者初始均接受NPPV治疗；其中9例（27．3％）NPPV失败后改用有创机械通气（1MV，失败组），最终全部死亡；24例（72．7％）仅用NPPV并成功（成功组），最终死亡7例（29．2％），两组间病死率比较差异有统计学意义（P〈0．01）。除成功组简化急性生理学评分Ⅱ（SAPSⅡ，分）显著低于失败组外（33±9比43±5，P〈O．01），两组其他临床资料比较差异无统计学意义。Logistic回归分析显示，SAPSⅡ是NPPV治疗成功的独立影响因素[优势比（OR）=0．83，95％可信区间（95％CI）0．709-0．964，P％O．053，且SAPSⅡ≥38分是NPPV失败的高危因素[受试者工作特征曲线（R0c）下面积为0．733。另外，生存组肺损伤评分（LIS，分）显著低于死亡组（1．95±0．48比2．57±0．52，P〈0．01），CD3＋、CD8＋T淋巴细胞亚群均高于死亡组（CD3＋：0．73±0．16比0．41±0．20；CD8：0．51±0．18比0．21±0．15，均P〈0．01）。结论NPPV可用于ICH肺部感染合并ARF的早期治疗，以SAPSⅡ〈38分作为NPPV治疗的选择时机，能有效改善缺氧，避免IMV相关并发症，利于ICH的预后；CD3＋、CD8＋及LIS评分可以作为评价预后的指标。Objective To evaluate the value of non-invasive positive pressure ventilation （NPPV） in immunoeompromised host （ICH） complicated by acute respiratory failure （ARF）, and to investigate predictive variables of success with NPPV in ICH with ARF. Methods A retrospective study of immunocompromised patients with ARF, who were admitted to respiratory intensive care unit （RICU） from March 2008 to March 2011, was performed. Based on clinical data, univariate Logistic regression was done for prediction for independent factors affecting the success of NPPV treatment. Immunization status was assessed according to clinical outcome. Results NPPV was instituted in all 33 cases with ARF initially. Among these patients, 9 patients （27.3 %） received sequential invasive mechanical ventilation （IMV, failure group ） and all of them died finally; among 24 cases （72.7%） who only received NPPV （success group）, 7 patients died （29.2%）. There was significant difference between the two groups in mortality （P（0.01）. The simplified acute physiology score ~ （SAPS % ） in the success group was lower than that in the failure group （33±9 vs. 43±5, P〈0. 01）. However, other clinical data showed no statistical significance between two groups. Univariate Logistic regression analysis identified SAPS Ⅱwas the independent factor associated with the success of NPPV treatment wodds ratio （OR） =0.83, 95% confidence interval （95% CI） 0. 709 - 0. 964, P〈0. 05]. And SAPS≥38 was a risk factor for the failure of NPPV [area under receiver operating characteristic （ROC） curve 0. 73]. In addition, the lung injury scores （LIS） in the survival group was significantly lower than that of the death group （1.95±0.48 vs. 2.57±0.52, P〈0.01）, the difference was statistically significant. CD3＋ and CD8＋ T counts in the survivors were higher than that of non-survivors （CD3＋..0.73±0.16 vs. 0.41±0.20; CD8＋： 0.51±0.18 vs. 0.21±0.15, both P〈0.01）, and the difference was statist

关 键 词：无创正压通气 免疫抑制 呼吸衰竭 急性 预后 

分 类 号：R563.8[医药卫生—呼吸系统]