摘要
目的 探讨应用无创正压通气 (NIPPV)救治慢性阻塞性肺疾病 (COPD)急性恶化并Ⅱ型呼吸衰竭后期失败的相关因素。方法 对 64例COPD急性恶化并Ⅱ型呼吸衰竭接受NIPPV治疗并获得初期成功的患者进行前瞻性研究 ,将其分为NIPPV治疗成功组和NIPPV后期失败组。对两组患者入院初的血气分析等指标及治疗 48h后并发症的发生率进行比较分析。对各项指标进行Logistic回归分析。 结果 NIPPV后期失败组患者年龄偏大 ,入院初的心率增快 ,血压下降 ,血糖升高 ,每日家庭活动评分 (ADL)记分降低及并发症发生率增高均较NIPPV治疗成功组明显。Logistic回归分析提示 ,血糖水平、ADL及并发症发生率对NIPPV后期失败有显著影响。治疗48h后NIPPV后期失败组的肺炎、心力衰竭和高血糖发生率显著高于NIPPV治疗成功组。结论COPD急性恶化并Ⅱ型呼吸衰竭应用NIPPV救治后期失败受上述多因素影响 。
Objective To investigate the factors associated with development of late faliure of non invasive positive ventilation(NIPPV)in patients with exacerbation of chronic obstructive pulmonary disease(COPD)and type Ⅱ respiratory faliure.Methods Sixty four patients with exacerbation of COPD and typeⅡ respiratory faliure,initially successfully treated with NIPPV,were studied prospectively and divided into two groups:①NIPPV success group and ② NIPPV late failure group.Clinical and physiological parameters were analysed comparatively between two groups. Logistic regresion analysis were used for factors associated with late failure of NIPPV. Results Age was older,heatr rate was higher and blood pressure was lower significantly in patients in NIPPV late failure group who also had a lower ADL score and higher morbidity of complications(particularly hyperglycaemia) on admission, compared with NIPPV success group. Logistic regression analysis shown that the occurrence of late failure of NIPPV was significantly associated with hyperglycaemia,ADL score and morbidity of complication.Fourty eight hours after therapy the prevallences of pneumonia,cardiac faliure and hyperglycaemia were more common markedly in the NIPPV late faliure group than the NIPPV success group.Conclusion Late failure of NIPPV in patients with COPD and type Ⅱ respiratory faliure was influenced by the above relevant factors.When occurrence of late faliure,NIPPV should be replaced promptly by invasive ventilation.
出处
《中国呼吸与危重监护杂志》
CAS
2003年第2期100-103,共4页
Chinese Journal of Respiratory and Critical Care Medicine
