摘要
目的探讨慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭患者使用无创正压通气(NIPPV)成功的临床预测因素。方法对84例AECOPD合并Ⅱ型呼吸衰竭使用NIPPV患者入院时的临床资料进行回顾性分析,比较NIPPV成功组和NIPPV失败组患者的临床特征和使用NIPPV前及NIPPV后2 h、4～6 h的血气指标,采用多因素Logistic回归分析筛选预测NIPPV成功的临床因素。结果 (1)共收治84例NIPPV患者,成功组64例,成功率为76%;失败组20例〔其中改为气管插管有创机械通气者15例(18%);死亡11例,病死率为13%〕。(2)成功组患者急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)评分低于失败组、T细胞亚群CD3+、CD4+、CD8+水平高于失败组、NIPPV前PaCO2高于失败组、NIPPV后4～6 h动脉血气分析pH值、PaCO2较失败组改善更明显,差异均有统计学意义(P<0.05)。(3)多因素Logistic回归分析显示APACHEⅡ评分对NIPPV成功的影响有统计学意义〔P=0.044,OR 1.796,95%CI(1.886,13.009)〕。结论对于APACHEⅡ评分低、T细胞亚群CD3+、CD4+、CD8+水平相对较高、NIPPV后4～6 h pH值和PaCO2变化显著的AECOPD合并Ⅱ型呼吸衰竭患者,NIPPV的应用易成功。
Objective To summarize the clinical outcome predictors for non - invasive positive pressure ventilation （NIPPV） in patients with acute exacerbations of chronic obstructive pulminary disease （AECOPD） complicated by type I1 respiratory failure. Methods The clinical and laboratory data of 84 patients with AECOPD complicated by type II respiratory failure who used NIPPV in our hospital from January 2011 to June 2012 were retrospectively analyzed. The clinical features and the blood gas indicators before and 2 and 4 - 6 h after NIPPV usage were compared between the success group and failure group using multi- variate Logistic regression analysis. Results Among these 84 patients, NIPPV was successful in 64 patients （76%） and failed in 20 patients （including 15 patients who changed to invasive mechanical ventilation and 11 cases of death）. Univariate analysis showed that, compared with the failure group, the success group had significantly lower APACHE II score, higher T - cell subsets （CD3＋ , CD;, CD8＋ ）, and higher PaCO2 before the initiation of NIPPV; However, the pH and PaCO2 were more remarkably improved in the success group than in the failure group 4 - 6 hours after NIPPY. Multivariate Logistic regression analysis revealed that APACHE II score [ P = 0. 044, OR 1. 796, 95% CI （ 1. 886, 13. 009） ] was an independent outcome predictor for NIPPV in patients with AECOPD complicated by type II respiratory failure. Conclusion For the patients with AECOPD complicated by type II respiratory failure patients, lower APACHE II score, higher T - cell subsets on admission and the more changed pH and PaCO2 at the 4 -6 h after NIPPV may predict better outcomes after NIPPV.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第2期147-150,共4页
Chinese General Practice
