无创正压通气治疗急性Ⅰ型呼吸衰竭的回顾性研究

Retrospective study on non-invasive positive pressure ventilation in patients with acute hypoxemic respiratory failure

目的探讨无创正压通气(NIPPV)治疗急性Ⅰ型呼吸衰竭的临床疗效。方法回顾分析2005年3月～2008年6月该院NIPPV治疗急性Ⅰ型呼吸衰竭的48例患者资料,根据NIPPV成功与否将患者分为成功组和失败组,比较两组患者的基本临床资料,以及NIPPV前、NIPPV后2h、NIPPV后24h的生命体征、动脉血气分析和氧合指数等变化。结果①NIPPV成功率为70.8%(34/48);NIPPV成功组平均年龄和肺部感染比例显著低于失败组患者(均P<0.01);NIPPV后2h和24h成功组氧合指数均较失败组显著升高(P<0.05);NIPPV后24h成功组心率和呼吸频率均比失败组有显著降低(均P<0.01)。②Logsitic回归分析显示NIPPV失败的危险因素为年龄>50岁[比值比(OR)=5.291,95%可信度区间(CI)为1.679～19.340]、呼吸衰竭诱因为肺部感染(OR=4.256,95%CI为1.387～15.606)、NIPPV后2h氧合指数<250mmHg(OR=3.374,95%CI为1.197～10.155)。结论NIPPV对急性Ⅰ型呼吸衰竭有确切的治疗作用,但对年龄偏大和肺部感染诱发的急性Ⅰ型呼吸衰竭疗效较差;应用NIPPV治疗2h后氧合指数仍偏低的急性Ⅰ型呼吸衰竭患者,应及早考虑有创通气。

【Objective】To explore the clinical effects of non-invasive positive pressure ventilation（NIPPV） in patients with acute hypoxemic respiratory failure（AHRF）.【Methods】48 cases with AHRF treated by NIPPV in Hospital from March 2005 to June 2008 were analyzed retrospectively.According to the outcome of NIPPV,patients were divided into success group and failure group.Basic clinical information,vital signs,arterial blood gas analysis,and PaO2/FiO2 before and after NIPPV in two groups were analyzed comparatively.【Results】Total successful rate of NIPPV was 70.8%（34/48）;mean age and pulmonary infection percentage of success group were lower significantly than those of failure group（both P〈0.01）;mean PaO2/FiO2 of success group were higher markedly than those of failure group after 2 hours and 24 hours of NIPPV（both P〈0.05）;heart rate（HR）,respiratory rate（RR） of success group were less significantly than those of failure group（both P〈0.01）.Logistic regression analysis identified age〉50 years（OR 5.291,95% CI 1.679～19.340）,pulmonary infection as induced factor of respiratory failure（OR 4.256,95% CI 1.387～15.606）,and PaO2/FiO2〈250 mmHg after 2 hours of NIPPV（OR 3.374,95%CI 1.197～10.155） as factors independently associated with failure of NIPPV.【Conclusions】NIPPV could have definite effect of therapy on AHRF without absolute contraindications.When patients of AHRF have an older age,pulmonary infection,the risk of failure of NIPPV is higher.If PaO2/FiO2 has not improved significantly after 2 hours of NIPPV,patients with AHRF should be considered invasive ventilation.