慢性阻塞性肺疾病合并呼吸衰竭患者无创呼吸机治疗失败的影响因素及其风险预测列线图模型构建  

Influencing Factors and Construction of Nomogram Model for Predicting the Risk of Noninvasive Ventilator Treatment Failure in Patients with Chronic Obstructive Pulmonary Disease and Respiratory Failure

作　　者：周大文 杨晓梅[1] 赵文婷 刘文君 王璐 ZHOU Dawen;YANG Xiaomei;ZHAO Wenting;LIU Wenjun;WANG Lu(Department of Respiratory and Critical Care Medicine,the Second People's Hospital of Huai'an,Huaian 223001,China;Hepatobiliary Surgery,the Second People's Hospital of Huai'an,Huaian 223001,China)

机构地区：[1]江苏省淮安市第二人民医院呼吸与危重症医学科,223001 [2]江苏省淮安市第二人民医院肝胆外科,223001

出　　处：《实用心脑肺血管病杂志》2023年第7期11-16,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：江苏省卫生计生委2018年度医学科研课题立项项目(H2018054)。

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者无创呼吸机治疗失败的影响因素,构建其风险预测列线图模型并进行验证。方法采用便利抽样法选取2020年5月至2022年5月于淮安市第二人民医院行无创呼吸机治疗的COPD合并呼吸衰竭患者为研究对象。纳入样本量为710例,将纳入患者按照7︰3分为建模组(497例)及验证组(213例)。收集患者的临床资料。COPD合并呼吸衰竭患者无创呼吸机治疗失败的影响因素分析采用多因素Logistic回归分析;采用R 4.1.0软件包及rms程序包建立COPD合并呼吸衰竭患者无创呼吸机治疗失败的风险预测列线图模型;采用Hosmer-Lemeshoe拟合优度检验评价该列线图模型的拟合程度;绘制校准曲线以评估该列线图模型预测COPD合并呼吸衰竭患者无创呼吸机治疗失败的效能;采用ROC曲线分析该列线图模型对COPD合并呼吸衰竭患者无创呼吸机治疗失败的预测价值。结果建模组497例COPD合并呼吸衰竭患者中,治疗失败129例,归为治疗失败组;治疗成功368例,归为治疗成功组。治疗失败组和治疗成功组年龄、机械通气时间和治疗前动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、pH值、呼吸频率、血清白蛋白、C反应蛋白(CRP)及入院时格拉斯哥昏迷量表(GCS)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、机械通气时间和治疗前PaO_(2)、PaCO_(2)、血清白蛋白、CRP及入院时APACHEⅡ评分是COPD合并呼吸衰竭患者无创呼吸机治疗失败的影响因素(P<0.05)。基于多因素Logistic回归分析结果,构建COPD合并呼吸衰竭患者无创呼吸机治疗失败的风险预测列线图模型。Hosmer-Lemeshoe拟合优度检验结果显示,建模组该列线图模型拟合较好(χ^(2)=6.355,P=0.607),验证组该列线图模型拟合较好(χ^(2)=6.337,P=0.591)。校准Objective To analyze the influencing factors of noninvasive ventilator treatment failure in patients with chronic obstructive pulmonary disease(COPD)and respiratory failure,and to construct a nomogram model for predicting its risk and validate it.Methods Patients with COPD and respiratory failure who underwent noninvasive ventilator therapy at the Second People's Hospital of Huai'an from May 2020 to May 2022 were selected as research subjects using a convenience sampling method.The included sample size was 710,and the included patients were divided into modeling group(n=497)and validation group(n=213)according to the ration of 7∶3.Clinical data of patients were collected.The multivariate Logistic regression analysis was used to analyze the influencing factors of noninvasive ventilator treatment failure in patients with COPD and respiratory failure.The nomogram model for predicting the risk of noninvasive ventilator treatment failure in patients with COPD and respiratory failure was constructed by using the R 4.1.0 software package and rms package.Hosmer-Lemeshow goodness of fit test was used to evaluate the fitting degree of the nomogram model.Calibration curve was drawn to evaluate the effectiveness of the nomogram model for predicting the risk of noninvasive ventilator treatment failure in patients with COPD and respiratory failure,and the ROC curve was used to analyze the predictive value of the nomogram model for noninvasive ventilator treatment failure in patients with COPD and respiratory failure.Results Among the 497 patients with COPD and respiratory failure in the modeling group,129 cases of treatment failure were classified as the treatment failure group;368 cases of treatment success were classified as the treatment success group.There were significant differences in age,mechanical ventilation time,pre-treatment arterial partial pressure of oxygen(PaO_(2)),pre-treatment arterial partial pressure of carbon dioxide(PaCO_(2)),pre-treatment pH value,pre-treatment respiratory rate,pre-treatment serum albu

关 键 词：肺疾病 慢性阻塞性 呼吸衰竭 通气机 机械 影响因素分析 列线图 

分 类 号：R563.9[医药卫生—呼吸系统]