慢性阻塞性肺疾病急性加重期患者无创通气治疗失败的危险因素分析  

Risk factors of noninvasive ventilation failure in AECOPD patients

作　　者：徐波 汪娟[1] XU Bo;WANG Juan(Huangshi Central Hospi-tal,Edong Healthcare,Huangshi 435000,China)

机构地区：[1]鄂东医疗集团黄石市中心医院,湖北黄石435000

出　　处：《内科急危重症杂志》2018年第5期375-377,共3页Journal of Critical Care In Internal Medicine

摘　　要：目的:分析慢性阻塞性肺疾病患者急性加重期(AECOPD)采用无创正压通气(NPPV)治疗失败的危险因素。方法:380例AECOPD患者接受NPPV治疗,按治疗结果分为失败组和成功组,比较2组基线资料、NPPV治疗前、治疗2 h后和稳定期相关指标,采用logistics回归分析法分析影响NPPV治疗失败的危险因素。结果:380例患者中,NPPV治疗失败45例(11. 84%);体质量指数、认知程度、接受NPPV治疗次数、治疗时间、抵触NPPV原因种数,治疗前急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评分、白蛋白含量,NPPV治疗后2h pH、动脉血二氧化碳分压(PaCO_2)、氧合指数(PaCO_2/FiO_2)、格拉斯哥昏迷量表评分(GCS)和稳定期动脉血CO_2分压(PaCO_2)均是影响NPPV治疗失败的因素(均P <0. 05);其中认知程度、接受NPPV治疗次数、NPPV治疗后2 h PaCO_2水平和GCS评分是影响NPPV治疗失败的独立危险因素。结论:认知程度、接受NPPV治疗次数、NPPV治疗后2 h PaCO_2水平和GCS评分是影响AECOPD患者NPPV治疗失败的独立危险因素。Objective： To analyze the risk factors of noninvasive positive pressure ventilation（ NPPV） failure in patients with acute exacerbation of chronic obstructive pulmonary disease（ AECOPD）. Methods： A total of 380 patients with AECOPD underwent NPPV and they were divided into the failure group and the success group according to treatment outcomes. The baseline data and related indexes before NPPV,at 2 h after treatment and in stable phase were compared between the two groups. Risk factors of NPPV failure were analyzed by logistics regression analysis. Results： In 380 patients,there were 45 cases（ 11. 84%） of NPPV failure. The body mass index,cognition degree,times of NPPV given,treatment time,causes of rejecting NPPV,the score of Acute Physiology and Chronic Health Evaluation Ⅱ（ Apache Ⅱ） before treatment,the albumin level,p H,PaCO2,oxygenation index（ PaCO2/FiO2）,Glasgow coma scale（ GCS） in 2 h after NPPV and arterial partial pressure of carbon dioxide（ PaCO2） in stable phase were single factors influencing NPPV failure（ all P〈0. 05）. Cognition degree,times of NPPV given,PaCO2 and GCS score in 2 h after NPPV were independent risk factors for NPPV failure.Conclusion： The cognitive degree,times of NPPV given,PaCO2 and GCS score in 2 h after NPPV are independent risk factors for NPPV failure.

关 键 词：急性生理与慢性健康状况评分Ⅱ 无创正压通气 危险因素 

分 类 号：R563[医药卫生—呼吸系统]