摘要
目的 探讨慢性肺源性心脏病(CPHD)合并Ⅱ型呼吸衰竭患者无创正压通气(NPPV)的疗效及与中性粒细胞与淋巴细胞比值(NLR)和降钙素原(PCT)的关系。方法 以164例CPHD合并Ⅱ型呼吸衰竭患者为研究对象。NPPV治疗1周后,统计CPHD合并Ⅱ型呼吸衰竭患者临床疗效,并分为无效组和有效组。对比无效组和有效组患者临床资料、NLR、PCT水平。多因素Logistic回归分析探讨CPHD合并Ⅱ型呼吸衰竭患者NPPV治疗效果的影响因素。制作受试者工作特征(ROC)曲线,分析NLR、PCT对CPHD合并Ⅱ型呼吸衰竭患者NPPV治疗效果的预测价值。结果 CPHD合并Ⅱ型呼吸衰竭患者NPPV治疗总有效率为81.10%(133/164)。无效组患者动脉血二氧化碳分压、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、纤维蛋白原、C反应蛋白、NLR及PCT水平高于有效组,动脉血氧分压水平低于有效组(P<0.05或0.01)。多因素分析结果显示,APACHEⅡ评分、NLR、PCT是CPHD合并Ⅱ型呼吸衰竭患者NPPV治疗效果的影响因素(P<0.05或0.01);ROC曲线显示,两者联合的曲线下面积为0.865,高于NLR和PCT的0.789和0.793,联合预测效果高于单项。结论 NPPV治疗CPHD合并Ⅱ型呼吸衰竭疗效确切,可有效改善患者血气功能指标;患者治疗前NLR、PCT水平对NPPV的临床疗效有预测作用,且NLR、PCT两者联合对CPHD合并Ⅱ型呼吸衰竭患者NPPV治疗效果预测的效能较高。
Objective To explore the curative effect of noninvasive positive pressure ventilation(NPPV)in the treatment of patients with chronic pulmonary heart disease(CPHD) complicated by type Ⅱrespiratory failure and its correlation with neutrophil to lymphocyte ratio(NLR) and procalcitonin(PCT).Methods A total of 164 patients with CPHD plus type Ⅱ respiratory failure were selected as study subjects.After 1 week treatment the clinical effects of the patients were counted and they divided into ineffective and effective group.Clinical data,NLR and PCT levels were compared between two groups.Influencing factors of NPPV curative effects were analyzed using the multivariate Logistic regression analysis.Receiver operating characteristic(ROC) curve was plotted to analyze the predictive value of NLR and PCT for the curative effect of NPPV in the patients.Results The total effective rate of NPPV in the patients was 81.10%(133/164).PaCO_(2) level,score on the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ),fibrinogen,C-reactive protein,NLR and PCT level were higher and PaO_(2) was lower in ineffective than effective group(P<0.05 or 0.01).Multivariate analysis showed that APACHE Ⅱscore,NLR and PCT were factors influencing the curative effect of NPPV in the patients(P<0.05 or 0.01);the ROC shows that the area under the curve of NLR and PCT combination was 0.865 and was higher than 0.789 of NLR or0.793 of PCT,the effect of combined prediction was higher than that of single item.Conclusion NPPV has a definite therapeutic effect on patients with CPHD plus type Ⅱ respiratory failure,can effectively improve the blood gas function indexes;pre-treatment NLR and PCT levels have a predicative role in clinical efficacy,the combination of NLR and PCT has higher value predicting therapeutic efficacy of NPPV.
作者
周华梅
杜丽明
许丹
郝琳
Zhou Huamei;Du Liming;Xu Dan;Hao Lin(Nanyang Nanshi Hospital,Nanyang 473000,Henan,China;不详)
出处
《临床心身疾病杂志》
CAS
2024年第2期51-56,共6页
Journal of Clinical Psychosomatic Diseases
基金
2019年度河南省医学科技攻关计划(编号LHGJ20191465)。
