无创正压通气对不同呼酸程度AECOPD患者疗效的预测因素分析

The analysis on the predictors of the efficacy of Noninvasive positive pressure ventilation in AECOPD patients with different degrees of respiratory acidosis

目的探讨无创正压通气对不同呼酸程度慢性阻塞性肺疾病急性加重（AECOPD）患者治疗成败的预测因素。方法根据动脉血气pH值将72例AECOPD患者分为轻、中、重度呼酸3组，分别比较3组中成功病例与失败病例在无创正压通气治疗前和治疗2h后的各项观察指标的差异有无统计学意义。结果无创正压通气治疗前，3组成功病例与失败病例的各项观察指标的差异无统计学意义。无创正压通气治疗2h后，轻度呼酸组，成功病例的视觉模拟评分、辅助呼吸肌动用评分、心率和呼吸频率显著低于失败病例（P〈O．05）；中度呼酸组，成功病例的呼吸频率和PaCO2显著低于失败病例（P〈0．05）；重度呼酸组，成功病例和失败病例的各项观察指标差异均无统计学意义。结论对于不同呼酸程度的AECOPD患者，在治疗早期应选择不同的临床观察指标评价预后。

Objective To investigate the predictors of the efficacy of Noninvasive positive pressure ventilation （NPPV） in AECOPD patients with different degrees of respiratory acidosis. Methods According to the PH value of the arterial blood gas analysis,72 cases of AECOPD patients were divided into three groups：mild respiratory acidosis,moderate respiratory acidosis and severe respiratory acidosis. The successful cases and the failure cases were compared with each other in three groups mentioned above before the NPPV treatment and 2 hours follow the treatment to find the significant difference between them. Results There was no significant difference between the successful cases and the failure cases in the three groups before the NPPV treatment. After 2 hours＇ NPPV treatment,comparing with failure cases in the mild respiratory acidosis group, several items were significantly improved in successful group （ P 〈 0.05） ,including the VAS score,SAMU score, heart rate and respiratory rate. In the moderate respiratory acidosis group, the respiratory rate and PaCO2 were significantly improved in successful group （ P 〈0.05） ,comparing to the failure cases. No significant differences were found in the severe respiratory acidosis group between the successful cases and the failure cases. Conclusions Different factors should be selected for the AECOPD patients with different degrees of respiratory acidosis to evaluate the prognosis in the early treatment.