150例急诊抢救室患者应用无创通气治疗的效果评价与预警信号分析  

Early warning signal analysis and effect evaluation of non-invasive ventilation for treatment of 150 acute critical care patients in emergency departments

作　　者：刘经乐 林锦乐 卢彦秀 窦清理 张文武[1,2] Liu Jingle;Lin Jinle;Lu Yanxiu;Dou Qingli;Zhang Wenwu(Department of Emergency Medicine,People's Hospital of Shenzhen Baoan District,Shenzhen 518100,Guangdong,China;Graduate School,Guangdong Medical University,Zhanjiang 524000,Guangdong,China)

机构地区：[1]深圳市宝安区人民医院急诊科,广东深圳518100 [2]广东医学院研究生院,广东湛江524000

出　　处：《中国中西医结合急救杂志》2021年第3期287-291,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：广东省深圳市科技计划项目(JCYJ20180305123707368);广东省深圳市医学重点学科建设经费项目(SZXK047);广东省深圳市“医疗卫生三名工程”高层次医学团队项目(SZSM201606067);广东省深圳市宝安区劳动模范和宝安工匠创新工作室项目(2020-10)。

摘　　要：目的分析急诊抢救室应用无创通气治疗患者的临床特征和相关流行病学信息.方法回顾分析2016年4月至2020年4月在深圳市宝安区人民医院急诊抢救室应用无创通气治疗的150例患者的临床资料.记录患者首发疾病类型、无创通气维持和转换时间、7 d和28 d临床结局.以无创通气72 h为观察节点,根据无创通气维持状态将患者分为无创通气成功组〔包括无创通气维持组(75例)和无创通气转吸氧组(36例)〕以及无创通气失败组(39例).收集患者入室生命体征(体温、心率、血压、呼吸频率、休克指数)、实验室检查指标〔N末端脑钠肽前体(NT-proBNP)、降钙素原(PCT)、血pH值、血氧分压、血二氧化碳分压、白细胞计数(WBC)、血红蛋白(Hb)、C-反应蛋白(CRP)、血肌酐(SCr)、总蛋白(TP)、白蛋白(ALB)〕等数据,比较各指标的差异.采用多因素Logistic回归分析急诊患者无创通气失败的危险因素.绘制受试者工作特征曲线(ROC),评价各危险因素对急诊抢救室患者无创通气成功的预测价值.结果共纳入150例无创通气患者,首发疾病以慢性肺部疾病急性加重和肺部感染为主,其次为急性冠脉综合征、慢性心力衰竭(心衰)急性发作.24 h内无创通气成功的有123例(82.0%)、72 h内无创通气成功的有111例(74.0%),7 d内死亡的有16例(10.7%),28 d内死亡的有24例(16.0%),其中脓毒症患者7 d和28 d病死率(分别为50.0%、60.0%)以及24 h和72 h转为气管插管的比例(分别为20.0%、50.0%)均明显高于其他疾病患者(均P<0.05).无创通气失败患者转插管时间多为48 h内,尤其是前12 h.无创通气失败组的心率、休克指数、WBC和CRP均明显高于无创通气成功组,收缩压和舒张压均明显低于无创通气成功组,两组间其余指标比较差异均无统计学意义;其中无创通气维持组和无创通气转吸氧组的休克指数、WBC和CRP均明显低于无创通气失败组.二项式Logistic逐步回�Objective To analyze the clinical characteristics of patients treated with non-invasive ventilation in emergency room,and provide relevant epidemiological information.Methods The clinical data of 150 patients admitted into the emergency department of People's Hospital of Shenzhen Baoan District from April 2016 to April 2020 and treated by non-invasive ventilation were analyzed retrospectively.Their diagnosis and treatment information were collected,including the original diseases,conversion time,maintenance duration of non-invasive ventilation,and outcomes in 7 days and 28 days of intervention.At the time point of 72 hours since starting non-invasive ventilation,the patients were divided into a successfully using non-invasive ventilation group[including maintenance of non-invasive ventilation group(75 cases)and conversing to oxygen inhalation group(36 cases)]and failure of using non-invasive ventilation group(39 cases).After admission,the data of vital signs(body temperature,heart rate,blood pressure,respiratory rate and shock index)and the results of laboratory examinations[N-terminal probrain natriuretic peptide(NT-proBNP),procalcitonin(PCT),serum pH,partial pressure of oxygen,partial pressure of carbon dioxide,white blood cell count(WBC),hemoglobin(Hb),C-reactive protein(CRP),serum creatinine(SCr),total protein and albumin(ALB)]were collected for statistically comparing the significance of differences of various indexes between various groups.Multivariate Logistic regression analysis was applied to assess the emergency patients'risk factors of failure in using non-invasive ventilation.The receiver operating characteristic(ROC)curves were drawn to evaluate the values of various risk factors in predicting success in patients receiving non-invasive ventilation in the emergency rescue department.Results A total of 150 patients with non-invasive ventilation were included.The predominant original disease was acute exacerbations of chronic obstructive pulmonary disease and pulmonary infection,followed by acute corona

关 键 词：无创通气治疗 急诊抢救室 回顾性分析 临床特征 转换时间 预测 

分 类 号：R54[医药卫生—心血管疾病]