无创机械通气治疗AECOPD并呼吸衰竭患者生存率的影响因素分析

Predicting survival following non-invasive ventilation for hypercapnic exacerbations of COPD

目的评价影响接受无创机械通气(NIV)治疗的慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭患者生存率的相关因素。方法回顾性分析接受HIV辅助治疗的AECOPD合并Ⅱ型呼吸衰竭患者187例,按照其生存结局分为存活组(S组)和死亡组(N组)。比较2组患者年龄、接受无创机械通气前、通气后1 h和4～6 h血气分析(pH值和PaCO2),评价NIV在AECOPD呼吸衰竭患者治疗过程中影响患者生存率的相关因素。结果 S组和N组患者年龄中位数(Median)分别为68岁和73岁(P<0.05);S组患者通气前、通气后1 h血气分析pH值均高于N组,PaCO2低于N组(P<0.05);S组机械通气1 h后血pH升高的患者比例高于N组。结论在接受NIV治疗的AECOPD合并Ⅱ型呼吸衰竭患者中,年龄较小、通气前血pH值较高、PaCO2较低以及通气后1 h血pH值升高者的存活几率更高。

Objective To evaluate factors related to the survival rate of the patients receiving non - invasive ventilation with hypercapnic exacerbations of chronic obstructive pulmonary disease. Methods The demographics, blood gases and outcomes （ survival or death） of 187 patients receiving NIV for a hypercapnic RF of AECOPD were analysed retrospectively. The factors relating to its overall success or failure were identified subsequently. Results The patients received NIV with mean pH and PaCO2 Prior to NIV 7.24 and 10.4kPa respectively. 167 survived to hospital discharge with a median age （68 vs 73 ,P 〈0. 05） lower than non -survivors. The values of higher pH lower PaCO2 prior to NIV and at 1 h in survival group was observed. An improvement in pH within one hour of receiving NIV was associated with surviving to hospital discharge （ P 〈 0.05 ）. Conclusion During NIV for hypercapnie RF of AECOPD, younger patients with a higher pH and lower PaCO2 prior to NIV and with an improvement in pH within 1 h are more likely to have a successful outcome.