AECOPD合并重度高碳酸血症无创通气治疗效果的预测因素研究  

Predictors for noninvasive positive pressure ventilation in AECOPD patients complicated with severe hypercapnia

作　　者：黄丽平 李秀 HUANG Li-ping;LI Xiu(Hefei First People＇ s Hospital,Hefei,Anhui 230000,China)

机构地区：[1]安徽医科大学第三附属医院,安徽合肥230000

出　　处：《临床肺科杂志》2018年第7期1245-1249,共5页Journal of Clinical Pulmonary Medicine

基　　金：安徽省2013年第三批科技计划项目;科技[2013]108号

摘　　要：目的通过对无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重(AECOPD)合并重度高碳酸血症(PaCO_2≥80mmHg)患者的临床资料进行回顾性研究,分析其失败的高危因素。方法按照本研究纳入和排除标准,搜集并选取161例AECOPD合并重度高碳酸血症并应用无创通气治疗患者的临床及实验室资料,按照治疗的效果分为NPPV成功组和失败组,对两组患者的资料进行对比分析,并采用多因素Logistic回归分析得出NPPV疗效的预测因素。结果 (1)治疗成功组的急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)评分、电解质紊乱的机率均低于失败组,初始Glasgow coma score(GCS)评分、D-二聚体、PH值均高于失败组,稳定期予以家庭氧疗或(和)家庭无创通气者人数多于失败组。(2)进行logistics多因素回归,最后进入回归方程的是初始GCS评分(P=0.033)。结论初始GCS评分较低是AECOPD合并重度高碳酸血症的患者行NPPV治疗失败的高危因素。Objective To analyze the risk factors of failure for noninvasive positive pressure ventilation（ NIPPV） in AECOPD patients complicated with severe hypercapnia（ Pa CO2≥80 mm Hg）. Methods NIPPV was used in 161 AECOPD patients with severe hypercapnia who had been selected according to the inclusion and exclusion criteria,and these patients＇ clinical and laboratory data were collected. They were divided into the NIPPV success group and the NIPPV failure group according to the effect of treatment. Multivariate logistic regression analysis was used to screen out predictors of NPPV efficacy. Results（ 1） The probability of acute physiology and chronic health scoring system Ⅱ（ APACHE Ⅱ） and the combined electrolyte imbalance in the NIPPV success group were lower than those in the failure group,the initial glasgow coma score（ GCS）,D-dimer,and PH value were higher in the success group than in the failure group,and family oxygen therapy or（ and） family noninvasive ventilator at stable period were much more in the success group than in the failure group.（ 2） The logistics regression results showed the initial GCS score was independent risk factor（ P = 0. 033）. Conclusion Low initial GCS score is a risk factor for failure of non-invasive mechanical ventilation in AECOPD patients complicated with severe hypercapnia.

关 键 词：慢性阻塞性肺疾病急性加重 呼吸衰竭 无创通气 相关因素 

分 类 号：R563.9[医药卫生—呼吸系统]