摘要
目的 研究无创正压通气 (NPPV)治疗急性呼吸衰竭 (ARF)失败的相关因素 ,探讨NPPV治疗失败需转换为有创通气的时机。方法 对 74例由各种病因所致ARF接受NPPV治疗患者根据治疗结果分为NPPV失败组和NPPV成功组 ,比较两组患者各项指标变化 ,分析与NPPV治疗失败相关的因素。结果 NPPV治疗失败 2 2例 (2 9 7% )。入院初NPPV失败组的呼吸频率 (RR)和心率 (HR)增快 ,动脉血二氧化碳分压 (PaCO2 )升高和pH下降 ,与NPPV成功组比较差异有显著性 (P <0 0 5 )。Logistic回归分析显示 ,RR >30次 /min ,HR >130次 /min ,PaCO2 >6 0mmHg ,pH <7 30是影响NPPV失败的相关因素。NPPV成功组治疗后 1～ 6h动脉血氧分压 (PaO2 )明显改善 ,与治疗前比较差异显著 (P <0 0 5 )。NPPV失败组治疗后 1～ 6h动脉血气与治疗前比较无明显改善。结论 ARF患者显著异常的RR、HR、PaCO2 和pH是与NPPV治疗失败相关的因素。NPPV治疗初期 (1～ 6h)动脉血气有无显著改善亦可作为预测NPPV治疗成功与否的指标。NPPV治疗失败时及时改用有创通气可降低病死率 ,改善预后。
Objective To study the factors associated with development of non-invasive positive pressure ventilation(NPPV)failure in patients with acute respiratory failure(ARF),to research the time that NPPV should be replaced by invasive ventilation when NPPV failure occurred.Methods Seventy-four patients with ARF resulted from variant diseases were investigated and divided into NPPV failure group and NPPV success group.Physiological and clinical parameters were studied comparatively between two groups.Factors associated with failure of NPPV were analysed.Results Failure rate of NPPV was 29.7%(22/74).Respiratory rate (RR),heart rate (HR)and PaCO_2 were higher and pH was lower significantly in patients in NPPV failure group on admission,compared with NPPV success group( P <0.05).Logistic regression analysis showed that the occurrence of NPPV failure was significantly associated with RR>30 breath/min,HR>130 beat/min,PaCO_2>60 mmHg and pH<7.3.In NPPY success group,there was obvious improvement of PaO_2 at one and six hours after NPPV therapy compared with baseline ( P <0.05).In NPPV failure group,there was not statistical difference in measured results of arterial blood gases between after and before NPPV therapy.Conclusions NPPV failure in patients with ARF was influenced by markedly abnormal RR,HR,PaCO_2 and pH.Improvement of arterial blood gases within 1～6 hours after NPPV was index for predicting success of treatment.NPPV should be replaced promptly by tracheal intubation and invasive ventilation when failure occurs.
出处
《中国急救医学》
CAS
CSCD
北大核心
2004年第3期175-177,共3页
Chinese Journal of Critical Care Medicine
关键词
急性呼吸衰竭
无创正压通气
治疗失败
相关因素
Acute respiratory failure(ARF)
Non-invasive positive pressure ventilation(NPPV)
Failure
Relevant factor
