HI-NPPV治疗AECOPD合并严重Ⅱ型呼吸衰竭的临床疗效  

Clinical efficacy of HI-NPPV in the treatment of AECOPD combined with severe type II respiratory failure

作　　者：姜锐 李雪娇[1] 贺银虹 李彦霖 王晓龙[1] JIANG Rui;LI Xuejiao;HE Yinhong;LI Yanlin;WANG Xiaolong(Department of Emergency,Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院急救部,重庆400010

出　　处：《中南大学学报（医学版）》2024年第2期266-272,共7页Journal of Central South University ：Medical Science

基　　金：重庆市卫生健康委员会适宜技术推广研究(2022jstg003)。

摘　　要：目的:慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并严重Ⅱ型呼吸衰竭患者使用常规无创正压通气(non-invasive positive pressure ventilation,NPPV)通气失败的概率较高。本研究旨在探讨高压力NPPV(high intensity NPPV,HI-NPPV)治疗AECOPD合并严重Ⅱ型呼吸衰竭的临床疗效。方法:收集2013年7月至2023年7月因AECOPD伴严重Ⅱ型呼吸衰竭(血气分析pH值≤7.25)在重庆医科大学附属第二医院进行NPPV治疗的患者资料,进行回顾性病例对照研究。根据NPPV治疗过程中采用的吸气相气道正压(inspired positive airway pressure,IPAP)将患者分为2组:NPPV组(IPAP<20 cmH2O,1 cmH2O=0.098 kPa)和HI-NPPV组(20 cmH2O≤IPAP<30 cmH2O)。NPPV组和HI-NPPV组分别纳入99和95例患者。通过倾向性得分匹配法(propensity score matching,PSM)进行数据配比,共匹配得到86对数据。比较2组的主要结局指标(病死率、气管插管率)及次要结局指标[血气分析的pH值、动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))和动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_(2)),不良反应率,住院时长]。结果:NPPV组和HI-NPPV组的气管插管率分别为6.98%和1.16%,2组之间差异有统计学意义(χ^(2)=4.32,P<0.05);NPPV组和HI-NPPV组的病死率分别为23.26%和9.30%,2组之间差异有统计学意义(χ^(2)=11.64,P<0.01)。HI-NPPV组治疗后24、48 h的PaO_(2)均高于NPPV组,PaCO_(2)均低于NPPV组,差异均有统计学意义(均P<0.05);治疗后24、48 h,2组之间p H值的差异无统计学意义(均P>0.05)。2组在不良反应率、住院时长方面的差异均无统计学意义(均P>0.05)。结论:HI-NPPV可通过迅速改善AECOPD合并严重Ⅱ型呼吸衰竭患者的通气状态,从而降低病死率及插管率,本研究为AECOPD合并严重Ⅱ型呼吸衰竭患者的治疗提供了新的思路。Objective:Patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)combined with severe type II respiratory failure have a high probability of ventilation failure using conventional non-invasive positive pressure ventilation(NPPV).This study aims to investigate the clinical efficacy of high intensity NPPV(HI-NPPV)for the treatment of AECOPD combined with severe type II respiratory failure.Methods:The data of patients with AECOPD combined with severe type II respiratory failure(blood gas analysis pH≤7.25)treated with NPPV in the Second Affiliated Hospital of Chongqing Medical University from July 2013 to July 2023 were collected to conduct a retrospective case-control study.The patients were divided into 2 groups according to the inspired positive airway pressure(IPAP)used during the NPPV treatment:a NPPV group(IPAP<20 cmH2O,1 cmH2O=0.098 kPa)and a HI-NPPV group(20 cmH2O≤IPAP<30 cmH2O).Ninety-nine and 95 patients were included in the NPPV group and the HI-NPPV group,respectively.A total of 86 pairs of data were matched using propensity score matching(PSM)for data matching.The primary outcome indexes(mortality and tracheal intubation rate)and secondary outcome indexes[blood gas analysis pH,arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2)),adverse reaction rate,and length of hospitalization]were compared between the 2 groups.Results:The tracheal intubation rates of the NPPV group and the HI-NPPV group were 6.98%and 1.16%,respectively,and the difference between the 2 groups was statistically significant(χ^(2)=4.32,P<0.05);the mortality of the NPPV group and the HI-NPPV group was 23.26%and 9.30%,respectively,and the difference between the 2 groups was statistically significant(χ^(2)=11.64,P<0.01).The PaO_(2)at 24 h and 48 h after treatment of the HI-NPPV group was higher than that of the NPPV group,and the PaCO_(2)of the HI-NPPV group was lower than that of the NPPV group,and the differences were statistically significant(all P<0.05).The

关 键 词：慢性阻塞性肺疾病急性加重 严重Ⅱ型呼吸衰竭 高压力无创正压通气 

分 类 号：R563[医药卫生—呼吸系统]