影响无创呼吸机依从性的Cox回归分析

Cox regression analysis of influencing factors of compliance with treatment with noninvasive ventilator

目的评估影响无创呼吸机治疗依从性的相关因素。方法 138例使用无创呼吸机患者,其中呼吸衰竭患者48例,阻塞性睡眠呼吸暂停低通气综合征患者130例(包括40例合并呼吸衰竭患者),收集患者的相关资料,对可能影响其治疗依从性的因素(性别、年龄、文化程度、吸烟与否、体质量指数、鼻部因素、基础疾病、认知能力、呼吸机压力释放方式、面罩类型、呼吸机输出压力、不良反应、心理状态、教育方式、居住情况、经济水平、确诊到呼吸机治疗执行时间)进行评定,并采用Cox回归全变量模型和逐步回归模型对以上因素进行分析。结果年龄<65岁(HR=2.513,95%CI:1.222～5.167)、文化程度高(HR=2.740,95%CI:1.765～4.255)、有Ⅰ型呼吸衰竭(HR=2.776,95%CI:1.547～4.982)、Ⅱ型呼吸衰竭(HR=2.545,95%CI:1.262～5.133)、高血压(HR=2.404,95%CI:1.550～3.729)、认知无障碍(HR=1.641,95%CI:1.114～2.416)、患者家属联合教育(HR=3.105,95%CI:1.687～5.715)、经济水平高(HR=1.871,95%CI:1.048～3.343)、双水平正压通气(BiPAP)(HR=2.329,95%CI:1.065～5.094)是提高患者无创呼吸机依从性的因素(P<0.05或P<0.01)。结论临床上应加强对年龄≥65岁、有认知障碍、文化程度低、经济水平较低以及使用的呼吸机压力释放方式为持续正压通气(CPAP)患者的教育,同时加强对患者家属的联合教育,以提高患者对无创呼吸机使用的依从性。

Objective To evaluate the influencing factors of compliance with treatment with noninvasive ventilator. Methods A total of 138 patients treated with noninvasive ventilator were investigated, among whom 48 experienced respiratory failure and 130 had obstructive sleep apnea-hypopnea syndrome （including 40 patients complicated with respiratory failure）. The related data of patients were collected, and the potential influencing factors of compliance with treatment with noninvasive ventilator were evaluated, including sex, age, educational background, smoking, body mass index, nasal factors, basic diseases, cognition, type of positive airway pressure, mask type, output pressure of noninvasive ventilator, adverse reactions, psychological status, education pattern, living conditions, economic status, and duration from diagnosis to treatment. The above factors were analysed with Cox regression analysis. Results Age 〈 65 years （HR = 2.513, 95%CI： 1.222 -5.167）, higher education level HR =2.740, 95%CI： 1.765 -4.255）, type I respiratory failure （HR = 2.776, 95% CI： 1.547 - 4.982）, type Ⅱ respiratory failure （HR = 2.545, 95% CI： 1.262 - 5. 133）, hypertension （HR = 2. 404, 95% CI： 1. 550 - 3. 729）, cogmtion （ HR = 1. 641, 95% CI： 1.114 - 2. 416）, patient-family education （ HR = 3. 105, 95% CI： 1. 687 - 5. 715）, high level economic status （HR = 1. 871, 95% CI： 1. 048 - 3. 343） and bi-level positive airway pressure （BiPAP）（HR = 2.329, 95% CI： 1.065 -5.094） were factors for improvement of compliance with treatment with noninvasive ventilator （P 〈 0.05 or P 〈 0.01）. Conclusion Education should be conducted on patients with age ≥ 65 years, lower education level, recognition disorder and continuous positive airwaypressure in ventilation, and patient-family education should be carried out to improve the compliance with treatment with noninvasive ventilator.