摘要
目的分析无创正压通气(noninvasive positive pressure ventilation,NPPV)治疗急性呼吸衰竭患者失败的预测因素,比较NPPV治疗失败后行气管插管与最初直接行气管插管治疗患者的预后,探讨NPPV治疗失败后行延迟气管插管对预后的影响。方法回顾性分析2013年1月至2018年1月河北省保定市第一医院重症医学科收治的163例急性呼吸衰竭接受NPPV治疗患者的临床资料,以同期收治的直接进行气管插管治疗的50例患者作为对照组。记录两组患者一般临床资料、简化急性生理Ⅱ评分、急性呼吸衰竭的病因,NPPV的相关参数,NPPV前、NPPV后的生命体征及血气分析结果等并进行统计分析。结果NPPV治疗失败者占30.2%,与NPPV治疗成功组比较,NPPV治疗失败者ICU停留时间延长(P<0.01),死亡率增高(P<0.01)。Logistic回归分析显示,脓毒症(OR=3.86,95%CI 1.35~10.77,P=0.01)、简化急性生理Ⅱ评分(OR=1.07,95%CI 1.02~1.12,P=0.01)和PF比值(OR=0.99,95%CI 0.99~1.00,P=0.02)是NPPV治疗失败的独立预测因素。NPPV治疗失败后行气管插管治疗的患者与最初直接行气管插管的患者相比,预后无明显差异。结论与NPPV治疗成功的急性呼吸衰竭患者相比,NPPV治疗失败患者的预后更差;但NPPV治疗失败后行气管插管治疗的预后与最初直接行气管插管治疗相似。因此,NPPV治疗用于急性呼吸衰竭是可行且有效的,与最初直接行气管插管预后相当。
Objective The purpose of this study is to assess rates and predictors of NPPV failure and to compare hospital outcomes of patients with NPPV failure with those patients primarily intubated without a prior NPPV trial.Method We screened and retrospectively analyzed clinical data during the period from January 2014 to January 2019.163 patients with acute respiratory insufficiency treated with NPPV in the ICU.We recorded the patient’s data including general state,Simplified Acute PhysiologyⅡ(SAPS-Ⅱ)score,the cause of acute respiratory insufficiency,the related parameters of NPPV,vital signs and blood gas analysis before and after NPPV.Result NPPV failure was recorded in 30.2%of noninvasively ventilated patients and was associated with longer ICU stay(P<0.01)and lower survival rates(P<0.01)compared with NPPV success.Multivariate analysis showed presence of severe sepsis at study entry(OR=3.86,P=0.01),higher SAPS-Ⅱscore(OR=1.07,P=0.01),and lower ratio of arterial oxygen tension to fraction of inspired oxygen(PF-ratio)(OR=0.99,P=0.02)were predictors for NPPV failure.After controlling for potential confounders,patients with NPPV failure did not show any difference in hospital outcomes compared with patients who were primarily intubated.Conclusion Patients with acute respiratory failure and NPPV failure have worse outcomes compared with NPPV success patients,however not worse than initially intubated patients.An initial trial of NPPV therefore may be suitable in selected cases of patients with acute respiratory failure,since NPPV could be potentially beneficial and does not seem to result in worse outcome in case of NPPV failure compared to primary intubation.
作者
王虹
王琳
王悦
赵顺成
张中学
褚娅琨
WANG Hong;WANG Lin;WANG Yue;ZHAO Shun-cheng;ZHANG Zhong-xue;CHU Ya-kun(Department of Intensive Care Unite,Baoding First Hospital,Hebei Baoding 071000,China)
出处
《中国医刊》
CAS
2019年第11期1193-1196,共4页
Chinese Journal of Medicine
关键词
重症监护病房
急性呼吸衰竭
无创正压通气
治疗失败
气管插管
病死率
Intensive care unit
Acute respiratory failure
Noninvasive positive pressure ventilation
Treatment failure
Endotracheal intubation
Mortality
