无创正压通气治疗慢性阻塞性肺病急性加重期呼吸衰竭患者的危险因素分析

Analysis of risk factors on treatment by noninvasive positive pressure ventilation for chronic obstructive pulmonary disease patients during acute stage

目的寻找能够预测无创通气疗效的常用指标,建立无创通气预后的预测模型。方法选取120例慢性阻塞性肺病(COPD)急性加重期合并Ⅱ型呼吸衰竭患者接受BiPAP呼吸机治疗。按照治疗效果患者分为无创通气成功组和无创通气失败组。以临床上常用的各项生理学指标为基础,对无创通气治疗成功和失败的患者进行Logistic多元回归分析,寻找无创通气失败的高危因素,并建立能预测无创通气预后的Logistic回归方程。结果多因素逐步Logistic回归分析显示接受治疗前的APACHEⅡ评分(OR值=2.300)和动脉血pH值(OR值=2.919)具有统计学意义,并得出Logistic回归方程:Logit(P)=145.620+0.833APⅡ-22.905pH。结论接受治疗前的APACHEⅡ评分和动脉血pH值是无创通气预后的独立危险因素。

Ohjective To find some usual indicators that coild prognosticate the effect of noninvasive ventilation and establish the logistic regression model. Methods 120 COPD patients with hypercapnia respiratory failure treated by BiPAP ventilation were enrolled. According to the curative effect, all patients were divided into NIPPV effective group and invasive ventilation group （NIPPV noneffective）, Multi - variable logistic regression analysis was used to find the risk factors of the failure in noninvasive ventilation and establish the regression equation that coild predict the prognosis of noninvasive ventilation. Results Multi - variable logistic analysis suggests statistical significance in APACHE Ⅱ scorn （OR= 2.300）and pH value（OR= 2.919）and elicits the regression equation：Logit（P） = 145.620 ＋ 0.833AP Ⅱ - 22.905pH. Conclusion APACHE Ⅱ score and pH value before treatment would be independent risk factors of the failure of NIV.