摘要
目的探讨有创-无创序贯通气治疗急性加重期慢性阻塞性肺疾病(AECOPD)患者切换失败的影响因素.方法回顾性分析2020年1月至2020年6月在浙江省义乌市中心医院就诊行有创-无创序贯机械通气治疗的AECOPD患者的临床资料,将其中成功切换为无创通气的55例患者作为序贯成功组,切换无创通气失败的10例患者作为序贯失败组.比较两组间一般资料和实验室指标水平,分析有创-无创序贯通气失败的原因.结果序贯成功组患者年龄、呼吸指数(RI)、排痰障碍、动脉血二氧化碳分压(PaCO_(2))、白细胞计数(WBC)、C-反应蛋白(CRP)、血乳酸(Lac)均显著小于序贯失败组[年龄(岁):65.49±5.40比69.57±5.58;RI:1.30(0.90,2.99)比1.95(1.01,3.38);排痰障碍例数(%):39(70.91)比10(100.00);PaCO_(2)(mmHg,1 mmHg≈0.133 kPa):73.48±12.06比83.70±11.93;WBC(×10^(9)/L):40.93±8.55比106.62±10.84;CRP(mg/L):54.85±13.85比36.78±10.93;Lac(mmol/L):1.90±0.66比3.02±0.63;均P<0.05];而性别、呼吸频率(RR)、平均动脉压(MAP)、格拉斯哥昏迷评分(GCS)、血红蛋白(Hb)、白蛋白比较差异均无统计学意义(均P>0.05).多因素Logistic回归分析结果显示,年龄、RI、排痰障碍、PaCO_(2)、WBC、Lac水平均是导致有创-无创通气患者序贯失败的独立危险因素[优势比(OR)及95%可信区间(95%CI)分别为4.491(1.551~13.004)、3.950(1.799~8.672)、2.894(1.235~6.782)、1.751(1.144~2.680)、0.121(0.372~0.039)、0.274(0.076~0.988),均P<0.05].结论年龄、RI、PaCO_(2)、Lac水平过高,WBC异常,排痰障碍是导致AECOPD患者有创-无创序贯通气切换失败的独立危险因素,临床应密切关注上述危险因素,结合临床各项指标,作出正确判断.
Objective To explore the influencing factors of switching failure in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)treated by invasive-noninvasive sequential ventilation.Methods The clinical data of AECOPD patients treated with invasive-noninvasive sequential ventilation in Yiwu Central Hospital of Zhejiang Province from January 2020 to June 2020 were retrospectively analyzed.Fifty-five patients who successfully switched to noninvasive ventilation were regarded as the success group and 10 patients who failed to switch to noninvasive ventilation were regarded as the failure group.The general data and laboratory index levels were compared between the two groups and the causes of invasive-noninvasive sequential ventilation failure were analyzed.Results The age,respiratory index(RI),sputum excretion disorder,arterial partial pressure of carbon dioxide(PaCO_(2)),white blood count(WBC),C-reactive protein(CRP)and blood lactic acid(Lac)of patients in the success group were significantly lower than those in the failure group[age(years):65.49±5.40 vs.69.57±5.58,RI:1.30(0.90,2.99)vs.1.95(1.01,3.38),sputum excretion disorder(cases,%):39(70.91)vs.10(100.00),PaCO_(2)(mmHg,1 mmHg,O.133 kPa):73.48±12.06 vs.83.70±11.93,WBC(X 109/L):40.93±8.55 vs.106.62±10.84,CRP(mg/L):54.85±13.85 vs.36.78±10.93,Lac(mmol/L):1.90±0.66 vs.3.02±0.63,all P<0.05].Multivariate regression analysis showed that age,RI,sputum excretion disorder,PaCO_(2),WBC and Lac were all the independent risk factors for ventilation failure in patients with invasive-noninvasive sequential ventilation[odds ratio(OR)and 95%confidence interval(95%C/)were 4.491(1.551-13.004),3.950(1.799-8.672),2.894(1.235-6.782),1.751(1.144-2.680),0.121(0.372-0.039),0.274(0.076-0.988),respectively,all P<0.05].Conclusions Age,high levels of RI,PaCO_(2) and Lac,abnormal WBC and sputum excretion disorder are all independent risk factors for the failure from invasive switching to noninvasive ventilation in patients with AECOPD.Clinically,close attentio
作者
李艳敏
成旭明
楼翰健
Li Yanmin;Cheng Xuming;Lou Hanjian(Department of Respiratory and Critical Care Medicine,Yiwu Central Hospital,Yiwu 322000,Zhejiang,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2022年第1期45-48,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
浙江省义乌市一般科研计划(社发类)项目(义科[2017]68号17-1-08)。
关键词
有创-无创序贯机械通气
切换无创通气
实验室指标
危险因素分析
Invasive-noninvasive sequential ventilation
Switch to noninvasive ventilation
Laboratory index
Bisk factor analysis
