脓毒症诱发的轻中度急性呼吸窘迫综合征患者无创通气失败因素  

Factors for the failure of noninvasive positive pressure ventilation for patients with mild or moderate acute respiratory distress syndrome induced by sepsis

作　　者：王虹[1] 董士民[2] 赵顺成[1] 王琳 张中学[1] 刘洪波[1] 褚娅琨 陈亚静 Wang Hong;Dong Shimin;Zhao Shuncheng;Wang Lin;Zhang Zhongxue;Liu Hongbo;Chu Yakun;Chen Yajing(Intensive Care Unit,Baoding First Hospital,Baoding 071000,China;Department of Emergency,the Third Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]保定市第一医院重症医学科,河北保定071000 [2]河北医科大学第三医院急诊科,河北石家庄050000

出　　处：《临床荟萃》2018年第11期966-969,973,共5页Clinical Focus

摘　　要：目的评价无创正压通气(NPPV)用于脓毒症诱发的轻、中度急性呼吸窘迫综合征(ARDS)的疗效及安全性,分析NPPV治疗失败的相关危险因素,以期更好地把握NPPV转为有创正压通气(IPPV)治疗的时机。方法采用回顾性研究方法,选取2013-2018年保定市第一医院重症医学科收治的严重脓毒血症合并ARDS的患者共78例,56例患者符合要求纳入研究。所有患者,均首先接受NPPV治疗,按无创通气后是否再行有创通气将患者分为成功组和失败组。观察两组入院时基本情况,应用无创通气的相关指标,观察两组无创通气前及无创通气2小时后生命体征、血气分析及氧合指数,最后对两组的ICU停留时间、住院时间、住院死亡率进行比较。分析与NPPV治疗失败的相关独立危险因素。结果 56例患者,成功组36例(64.3%),失败组20例(35.7%)。与成功组比较,失败组的平均年龄高、急性生理与慢性健康评分(APACHEⅡ)高、因肺部感染导致的ARDS的比例较高(P均<0.05),NPPV治疗2小时后成功组的氧合指数(PaO2/FiO2)较失败组明显改善(P <0.01);通过Logistic回归分析发现,APACHEⅡ评分高(P=0.039)、NPPV 2小时后氧合指数仍<145mmHg(P=0.000)、NPPV治疗2小时后呼吸频率仍>30次/min(P=0.016)、因肺部感染导致的ARDS(P=0.026)是NPPV治疗失败的独立危险因素。结论无创通气是治疗脓毒症诱发的轻、中度ARDS的有效方法,且有较好的安全性。患者APACHEⅡ评分高、NPPV2小时后氧合指数仍<145mmHg、NPPV治疗2小时后呼吸频率仍>30次/min、因肺部感染导致的ARDS是预测NPPV失败的独立危险因素。Objective To evaluate the clinical efficacy and safety of noninvasive positive pressure ventilation（NPPV） for patients with mild or moderate acute respiratory distress syndrome（ARDS） induced by sepsis, and to analyze the independent risk factors of NPPV treatment failure.Methods A retrospective observation was conducted. NPPV was used for mild or moderate ARDS patients induced by sepsis who admitted to Intensive Care Unit of Baoding First Hospital from January 2013 to December 2018. Fifty-six patients with ARDS treated with NPPV,according to whether patients needed invasive ventilation finally, were divided into success group and failure group. The data included general state, Acute Physiology and Chronic Health Evalution Ⅱ （APACHEⅡ） score,ARDS cause, NPPV related parameters, vital signs and blood gas analysis before and after NPPV.Results Of all the patients, 36 fell into the success group, while 20 （ 35.7% ） were included failure group. The multivariate analysis showed that higher APACHEⅡ score（ P = 0.039 ）,PaO 2/ FiO 2〈145 mmHg after two hours of NPPV（ P = 0.000 ）, RR〉30 times/min after two hours of NPPV（ P = 0.016 ）, and pulmonary infection derived ARDS（ P = 0.026 ） were the independent risk factors of NPPV treatment failure.Conclusion NPPV might be an effective and safe method for treatment of patients with mild or moderate ARDS induced by sepsis. The independent risk factors associated with failure of NPPV were higher APACHEⅡ score, PaO 2/FiO 2 〈145 mmHg after two hours of NPPV, RR〉30 times/min after two hours of NPPV, and pulmonary infection derived ARDS.

关 键 词：通气 人工 脓毒症 呼吸窘迫综合征 因素分析 统计学 

分 类 号：R631[医药卫生—外科学]