无创机械通气治疗COPD合并Ⅱ型呼吸衰竭患者的临床疗效及治疗失败影响因素分析  

Clinical Efficacy of Non-invasive Mechanical Ventilation in Treatment of COPD Patients with Type Ⅱ Respiratory Failure and Factors Analysis Affecting Therapeutic Failure

作　　者：王桂芳[1] 刘小兰 李松桃[1] WANG Gui-fang;LIU Xiao-lan;LI Song-tao(Department of Respiratory and Critical Medicine,the Sixth People's Hospital of Chengdu,Chengdu 610051,China)

机构地区：[1]成都市第六人民医院呼吸与危重症医学科,成都610051

出　　处：《解放军医药杂志》2021年第6期63-66,70,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：四川省医学会科研课题(Q18001615)。

摘　　要：目的分析经无创机械通气治疗COPD合并Ⅱ型呼吸衰竭患者的临床疗效,并探讨其治疗失败的影响因素。方法回顾性分析本院2018年4月—2020年7月收治的92例COPD合并Ⅱ型呼吸衰竭患者的临床资料,纳入者均给予无创机械通气,比较其治疗前后动脉血气分析、生命体征、肺通气功能、心率(HR)、呼吸频率(RR)及血压变化,病死率及并发症发生情况。分析COPD合并Ⅱ型呼吸衰竭患者临床疗效及治疗失败影响因素。结果与治疗前比较,本组92例患者治疗后pH值、氧分压(PaO_(2))、用力肺活量、第1秒用力呼气容积、第1秒用力呼气容积占预计值的百分比、第1秒用力呼气容积占用力肺活量百分比均显著升高,二氧化碳分压(PaCO_(2))、RR、HR均显著下降,差异有统计学意义(P<0.01)。92例患者住院期间病死率为2.17%(2/92),气管插管率为8.70%(8/92),并发症发生率为38.04%(35/92)。急性生理学和慢性健康状况评分系统Ⅱ评分、pH值、PaCO_(2)、PaO_(2)是导致COPD合并Ⅱ型呼吸衰竭患者无创机械通气治疗失败的独立危险因素(P<0.01)。结论采用无创机械通气治疗COPD合并Ⅱ型呼吸衰竭,可有效缓解患者临床症状,改善血气指标和肺通气功能。适用于大部分COPD合并Ⅱ型呼吸衰竭患者,合理应用并掌握适应证可降低治疗失败率。Objective To analyze clinical efficacy of non-invasive mechanical ventilation in treatment of chronic obstructive pulmonary disease(COPD)patients with type Ⅱ respiratory failure and to explore factors affecting therapeutic failure.Methods Clinical data of 92 COPD patients with type Ⅱ respiratory failure admitted during April 2018 and July 2020 was retrospectively analyzed.All patients were treated with non-invasive mechanical ventilation.Changes in arterial blood gas analysis,vital signs,pulmonary ventilation function,heart rate(HR),respiratory rate(RR)and blood pressure,mortality rate,and incidence rate of complications before and after treatment were compared.Clinical efficacy and related factors affecting therapeutic failure in COPD patients with type Ⅱ respiratory failure were analyzed.Results After treatment,values of pH,PaO_(2) level,forced vital capacity(FVC),forced expiratory volume in one second(FEV1),forced expiratory volume in one second as a percentage of estimated value(FEV1%)and FEV1/FVC were significantly higher,while values of PaCO_(2) level,RR and HR were significantly lower than those before treatment in all the 92 patients(P<0.01).Mortality rate,tracheal intubation rate and incidence rate of complications of 92 patients during hospitalization were 2.17%(2/92),8.70%(8/92)and 38.04%(35/92)respectively.Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,pH value,PaCO_(2) and PaO_(2) were independent risk factors leading to the failure of non-invasive mechanical ventilation therapy(P<0.01).Conclusion Non-invasive mechanical ventilation in treatment of COPD patients with typeⅡrespiratory failure may effectively relieve clinical symptoms and improve Qi and blood indexes and lung ventilation function.It is appropriate for most COPD patients with type Ⅱ respiratory failure.Reasonable application and grasping indications may help reduce failure rate of the treatment.

关 键 词：肺疾病 慢性阻塞性 无创机械通气技术 呼吸功能不全 肺通气 血压 危险因素 

分 类 号：R563.9[医药卫生—呼吸系统]