摘要
目的研究无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重(AECOPD)合并重度呼吸酸性中毒(PH<7.25)疗效相关因素,为临床合理应用NPPV提供依据。方法回顾性研究NPPV治疗AECOPD合并重度呼吸性酸中毒(PH<7.25)患者90例,按照转归分为失败组与成功组,比较两者临床指标,并应用logistic回归筛选出独立影响因素。结果①共收集90例病人,68例(75.6%)NPPV成功,22例(24.4%)NPPV失败。②NPPV治疗前格拉斯哥昏迷评分(GCS)、急性生理与慢性健康评分(APACH II评分),及NPPV治疗2-4h PaCO_2值、GCS,成功组与失败组差别有统计学意义(P<0.05);③多因素Logistic回归分析结果显示:NPPV治疗2-4h后GCS评分(OR=0.451,95%CI 0.221-0.923)和NPPV治疗2-4h后PaCO_2值(OR=1.054,95%CI=1.012-1.098)。结论 NPPV治疗AECOPD合并重度呼吸性酸中毒失败的可能因素为NPPV治疗2-4h后低GCS评分和高PaCO_2值。
Objective To investigate the effect of noninvasive positive pressure ventilation (NPPV) on acute exacerbation of chronic obstructive pulmonary disease complicated with severe respiratory acidosis (pH<7.25). Methods A retrospective study was conducted on NPPV in treatment of 90 cases of AECOPD complicated with severe respiratory acidosis (pH<7.25), and they were divided into two groups according to clinical outcomes. It used Logistic regression to screen independent influencing factors. Results 1. 90 patients were enrolled, 68 cases (75.6%) were successfully treated with NPPV, and 22 cases (24.4%) had failed. 2. There were significant differences in the scores of Glasgow coma score (GCS) before treatment with NPPV and PH, PaCO 2, the scores of Glasgow coma score (GCS) 2-4 hours after treatment between the two groups ( P <0.05). 3. The logistic regression analysis showed that the GCS score ( P <0.05, OR =0.451, 95% CI 0.221-0.923) and PaCO 2 ( P <0.05, OR =1.054, 95% CI 1.012-1.098) 2-4 hours after NPPV treatment was the only independent significant factors associated with NPPV failure. Conclusion The lower GCS scores and the higher PaCO 2 2-4 hours after NPPV treatment suggests that the treatment is possibly failed.
作者
范小玉
李秀
FAN Xiao-yu;LI Xiu(Department of Pulmonary Medicine, the Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230001, China)
出处
《临床肺科杂志》
2019年第5期822-826,共5页
Journal of Clinical Pulmonary Medicine
关键词
慢性阻塞性肺疾病急性加重
无创正压通气
重度呼吸性酸中毒
呼吸衰竭
相关因素
acute exacerbation of chronic obstructive pulmonary disease
noninvasive positive pressure ventilation
respiratory failure
severe respiratory acidosis
related factors
