摘要
目的探讨无创正压通气(NPPV)治疗Ⅱ型呼吸衰竭失败的预测因素。方法前瞻性收集首都医科大学附属北京朝阳医院呼吸重症监护病房2004年1月至2009年12月应用NPPV治疗Ⅱ型呼吸衰竭患者的临床资料,根据NPPV成功与否将患者分为成功组与失败组,比较两组患者的基础资料,在NPPV前、NPPV2 h后及NPPV24 h后的主要生命体征和血气分析等的变化以及不良反应的发生情况,分析失败原因并寻找失败的危险因素。结果共89例患者入选,其中16例患者NPPV失败。失败组NPPV前白细胞计数和中性粒细胞比例(N)显著高于成功组(P<0.05),血红蛋白(Hb)、白蛋白(ALB)、前白蛋白显著低于成功组(P<0.05)。与NPPV前比较,成功组pH、动脉血二氧化碳分压(PaCO2)及心率(HR)在NPPV2 h后和NPPV24 h后均有显著改善(P<0.05);失败组pH和HR无明显变化(P>0.05),PaCO2在NPPV24 h后有显著改善(P<0.05)。但与成功组比,改善幅度缩小。排痰障碍致呼衰加重是NPPV失败的主要原因,失败组中有11例患者均因此给予气管插管。多因素分析发现,NPPV前N≥0.90、NPPV前ALB<28 g/L以及出现不良反应为排痰障碍为NPPV失败的高危因素。结论 NPPV可作为无绝对禁忌证的Ⅱ型呼吸衰竭患者的首选呼吸支持方式。对于肺部感染较重、出现排痰障碍或营养状况较差患者,NPPV失败的危险性较高;对于在短时间应用NPPV后pH、PaCO2、血流动力学状况无明显改善或改善幅度较小患者,或Hb水平较低患者,NPPV失败的可能性也较大。
Objective To investigate the predictors of failed noninvasive positive pressure ventilation （NPPV） in patients with type Ⅱ respiratory failure. Methods The clinical data of 89 patients with type II re- spiratory failure on NPPV in respiratory intensive care unit （ RICU ） of Beijing Chao-Yang Hospital from January 2004 to December 2009 were collected prospectively. Baseline characteristics, change of vital signs, arterial blood gas analysis before, at 2 h and 24 h after NPPV, and adverse effects were compared between success group （ n = 73 ） and failure group of NPPV （n = 16 ）. The relevant factors associated with NPPV failure were identified. Results Compared with success group, failure group had significantly higher total white blood cell counts, ratio of neutrophil, and lower levels of hemoglobin, albumin and prealbumin （ P 〈 0. 05 ）. Success group had significant im- provements in pH, PaCO2 and HR at the 2 and 24 hours after application of NPPV （P 〈 0. 05 ） , while failure group did not show any changes in pH and HR （ P 〉 0. 05 ） but a significant improvement in PaCO2 at 24 hours after application of NPPV （ P 〈 0.05 ） with smaller amplitude. Exacerbation of respiratory failure due to difficult expectoration was the major cause of NPPV failure, which led to endotraeheal intubation in Ⅱ patients of failure group.Multivariate analysis identified ratio of neutrophil ≥ 0. 9 prior to NPPV （ OR = 9. 86,95% CI 1.28 - 76. 02, P = 0. 028）, albumin 〈 28 g/L prior to NPPV （ OR = 11.30,95% CI 11.42 - 90. 08, P = 0. 022） and difficult expectoration （ OR = 213.62,95% CI 11.93 - 3826.03, P = 0. 000） as independent factors associated with failure of NPPV. Conclusion In type ]] respiratory failure, NPPV could be the first-line respiratory support in selected populations. In cases with severe pulmonary infection, difficult expectoration, or poor nutritional status, the risk of failed NPPV can be higher. In addition, NPPV are likely to be unsuccessful in patients with no
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2011年第4期278-281,共4页
Chinese Journal of Practical Internal Medicine
基金
北京市科技新星计划(2008A021)
关键词
Ⅱ型呼吸衰竭
无创正压通气
type Ⅱ respiratory failure
noninvasive positive pressure ventilation
