AECOPD合并呼吸衰竭的风险预警模型建立及应对策略分析  

Establishment of a risk warning model for respiratory failure in patients with acute exacerbation of chronic obstructive pulmonary disease and analysis of response strategies

作　　者：樊媛媛[1] 庞晓倩 郭祯 Fan Yuanyuan;Pang Xiaoqian;Guo Zhen(RICU,Henan Chest Hospital,Zhengzhou 450000,China;Department of Medical Laboratory,Henan Chest Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院呼吸重症监护病房,郑州450000 [2]河南省胸科医院医学检验科,郑州450000

出　　处：《国际医药卫生导报》2025年第5期849-854,共6页International Medicine and Health Guidance News

基　　金：河南省医学科技攻关计划(LHGJ20230118)。

摘　　要：目的构建慢性阻塞性肺疾病急性加重期(AECOPD)患者合并呼吸衰竭风险预警模型,并分析应对策略。方法回顾性选取2022年6月至2024年3月期间河南省胸科医院收治的186例AECOPD患者作为研究对象,根据是否合并呼吸衰竭将其分为呼吸衰竭组(40例)和非呼吸衰竭组(146例)。呼吸衰竭组男22例、女18例,≥60岁24例、<60岁16例。非呼吸衰竭组男87例、女56例,≥60岁86例、<60岁60例。比较两组患者的临床资料。采用二元logistic回归分析影响AECOPD合并呼吸衰竭的风险因素并构建预警模型,采用受试者操作特征曲线分析该模型预测AECOPD合并呼吸衰竭的效能。采用χ^(2)检验、t检验、成对Z检验进行统计分析。结果呼吸衰竭组的机械通气时间、入院时急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、治疗前C反应蛋白(CRP)水平均高于非呼吸衰竭组[(15.38±5.83)d比(7.55±2.35)d、(25.35±6.97)分比(16.55±7.14)分、(80.31±8.47)g/L比(62.26±10.14)g/L],治疗前血清白蛋白水平低于非呼吸衰竭组[(20.19±5.65)g/L比(32.48±6.56)g/L],差异均有统计学意义(均P<0.05)。机械通气时间、入院时APACHEⅡ评分和治疗前血清白蛋白、CRP水平均是AECOPD患者合并呼吸衰竭的影响因素(均P<0.05)。构建相关预测模型,模型公式=8.811-0.715×机械通气时间-0.203×入院时APACHEⅡ评分+0.806×治疗前血清白蛋白水平-0.241×治疗前CRP水平。机械通气时间、入院时APACHEⅡ评分、治疗前血清白蛋白水平、治疗前CRP水平、预测模型的曲线下面积分别为0.888、0.810、0.928、0.911、0.949,灵敏度分别为0.850、0.750、0.890、0.875、0.904,特异度分别为0.877、0.767、0.850、0.795、0.900。结论针对AECOPD患者合并呼吸衰竭的风险,应建立综合预警模型,结合机械通气时间、入院时APACHEⅡ评分和治疗前血清白蛋白、CRP水平进行早期风险评估。对高危患者应加强监测,及时调整治疗方案Objective To construct a risk warning model for respiratory failure in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to analyze coping strategies based on this model.Methods A total of 186 AECOPD patients admitted to Henan Chest Hospital from June 2022 to March 2024 were retrospectively selected as the study objects and were divided into a respiratory failure group(40 cases)and a non-respiratory failure group(146 cases)according to whether they were complicated with respiratory failure.In the respiratory failure group,there were 22 males and 18 females,24 patients≥60 years old and 16 patients<60 years old.In the non-respiratory failure group,there were 87 males and 56 females,86 patients≥60 years old and 60 patients<60 years old.The general clinical data of the two groups were compared.Binary logistic regression analysis was used to analyze the factors affecting AECOPD patients with respiratory failure,and an early warning model was constructed.The effectiveness of the model in predicting respiratory failure in AECOPD patients was analyzed by the receiver operating characteristic curve.χ^(2) test,t test,and paired Z test were used for statistical analysis.Results The mechanical ventilation time,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,and C-reactive protein(CRP)level before treatment in the respiratory failure group were higher than those in the non-respiratory failure group[(15.38±5.83)d vs.(7.55±2.35)d,(25.35±6.97)points vs.(16.55±7.14)points,(80.31±8.47)g/L vs.(62.26±10.14)g/L],but the serum albumin level before treatment was lower than that in the non-respiratory failure group[(20.19±5.65)g/L vs.(32.48±6.56)g/L],with statistically significant differences(all P<0.05).Mechanical ventilation time,APACHEⅡscore at admission,and serum albumin and CRP levels before treatment were all factors influencing respiratory failure in AECOPD patients(all P<0.05).A relevant prediction model was constructed,and the model formula was 8.811-0.715×me

关 键 词：慢性阻塞性肺疾病急性加重期 呼吸衰竭 风险预警模型 诊断效能 

分 类 号：R56[医药卫生—呼吸系统]