摘要
目的分析免疫抑制患者合并急性呼吸衰竭（ARF）时无创正压通气（NIPPV）的成功率以及治疗失败的预警因素。方法回顾性分析2012年2月至2017年8月在新疆医科大学第一附属医院呼吸加强治疗病房（RICU）收治的118例接受NIPPV治疗免疫抑制合并ARF患者的临床资料。根据是否给予气管插管（ETI）将患者分为无ETI组（62例）和ETI组（56例）。比较两组患者各项指标的差异，对其中与NIPPV失败相关的因素进一步采用多因素Logistic回归分析；绘制受试者工作特征曲线（ROC），评价预警因素对NIPPV失败的预测价值。结果免疫抑制患者合并ARF时NIPPV成功率为50.8%（60/118）。与无ETI组比较，ETI组患者体温、pH值明显升高，动脉血二氧化碳分压（PaCO2）明显降低，氧合指数（PaO2/FiO2）〈100 mmHg（1 mmHg＝0.133 kPa）的比例、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分≥20分的比例以及使用血管活性药物的比例均明显增高，病死率明显升高。多因素Logistic回归分析显示，入院时APACHEⅡ评分≥20分〔优势比（OR）＝15.274，95%可信区间（95%CI）＝2.175～107.252，χ2＝7.516，P＝0.006〕、PaO2/FiO2〈100 mmHg（OR＝0.075，95%CI＝0.014～0.408，χ2＝8.968，P＝0.003）、使用血管活性药物（OR＝35.736，95%CI＝6.974～183.124，χ2＝18.400，P〈0.001）是NIPPV失败的独立危险因素。ROC曲线分析显示，APACHEⅡ评分≥20分和PaO2/FiO2〈100 mmHg均可预测NIPPV失败，APACHEⅡ评分≥20分的ROC曲线下面积（AUC）为0.787，敏感度为83.93%，特异度为69.35%，阳性预测值（PPV）为71.21%，阴性预测值（NPV）为82.69%，阳性似然比（PLR）为2.74，阴性似然比（NLR）为0.23，约登指数为0.53；PaO2/FiO2〈100 mmHg的AUC为0.757，敏感度为80.65%，特异度为66.07%，PPV为68.18%，NPV为78.85%，PLR为2.38，NLR为0.29，约登指数为0.47。结论50.8%的免疫抑制患者合并
ObjectiveTo evaluate the predictive factors for failure of non-invasive positive pressure ventilation （NIPPV） in immunosuppressed patients with acute respiratory failure （ARF）.Methods
The clinical data of 118 immuno-deficient patients treated with NIPPV in the respiratory and intensive care unit （RICU） of the First Affiliated Hospital of Xinjiang Medical University from January 2012 to August 2017 were retrospectively analyzed. The patients were divided into a non-endotracheal intubation （ETI） group （n = 62） and ETI group （n = 56） according to whether ETI was performed during the hospitalization period or not. Each observed indicator was analyzed by univariate analysis, and factors leading to failure of NIPPV were further analyzed by Logistic regression. Receiver operating characteristic （ROC） curve was plotted to evaluate the predictive value of risk factors for failure of NIPPV in immunosuppressed patients with ARF.ResultsThe non-intubation rate for NIPPV in immunosuppressed patients was 50.8% （60/118）. Compared with the non-ETI group, the body temperature, pH value in the ETI group were significantly increased, the partial pressure of arterial carbon dioxide （PaCO2） was significantly decreased, the ratio of oxygenation index （PaO2/FiO2） 〈 100 mmHg （1 mmHg = 0.133 kPa）, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score ≥ 20, and the number of cases requiring catecholamine were significantly increased, the mortality was significantly increased. Multivariate Logistic regression analysis showed that the APACHE Ⅱ score ≥ 20 [odds ratio （OR） = 15.274, 95% confidence internal （95%CI） = 2.175-107.252, χ2 = 7.516, P = 0.006], PaO2/FiO2 〈 100 mmHg （OR = 0.075, 95%CI = 0.014-0.408, χ2 = 8.968, P = 0.003）, and need for catecholamine （OR = 35.736, 95%CI = 6.974-183.124, χ2 = 18.400, P 〈 0.001） were independent risk factors for failure of NIPPV. ROC curve analysis showed that the APACHE Ⅱ score ≥ 20 and PaO2/FiO2 〈 100
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2018年第2期107-111,共5页
Chinese Critical Care Medicine
基金
新疆维吾尔自治区科技计划项目（201517103）
关键词
无创正压通气
机械通气
急性呼吸衰竭
免疫抑制
Non-invasive positive pressure ventilation
Mechanical ventilation
Acute respiratory failure
Immunosuppression
