小儿急性呼吸衰竭机械通气治疗的临床分析

Clinical analysis of mechanical ventilation for children with acute respiratory failure

目的研究急性呼吸衰竭(ARF)患儿实施无创正压机械通气(NIPPV)治疗的疗效影响因素。方法回顾性分析自2010年2月至2013年12月的187例ARF患儿临床资料,依据NIPPV治疗的成功与否将患儿分为成功组(n=117)与非成功组(n=70例),采取单因素及Logistic回归对患儿临床资料予以分析。结果 MPPV治疗的成功率是62.6%(117/187)。其中成功组实施治疗1小时后的PaCO_2值同治疗前相较明显下降,呈显著差异(t=9.1079,P<0.01),非成功组实施治疗1小时后的PaCO_2值同治疗前相较,无统计学差异(t=1.8167,P>0.05)。经单因素分析,同NIPPV实施治疗后效果相关的因素包括治疗1小时后患儿PaCO_2值(t=-6.295,P<0.05)、APACHEⅡ的评分(t=-6.443,P<0.05)、呼吸指数(t=1.229,P<0.05)、治疗前的PaCO_2值(t=-2.122,P<0.05)、神经源性的肺水肿(x^2=6.869,P<0.05)、间质性肺病(x^2=5.485,P<0.05)。Logistic多因素回归分析显示:治疗1小时后的PaCO2值(95%CI:0.845~0.958)、APACHEⅡ的评分(95%CI:0.281~0.711)、呼吸指数(95%CI:0.001~0.323)、神经源性的肺水肿(95%CI:4.137~6107.726),均具有统计学意义(均P<0.05)。结论对ARF患儿实施抢救应用NIPPV治疗时,需避免或者及时处理能够影响疗效的危险因素,可提高治疗的成功率。

Objective To study the influencing factors of non-invasive positive pressure ventilation （NIPPV） for children with acute respiratory failure （ARF）. Methods A retrospective analysis was conducted on clinical data of 187 children with ARF treated during the period of February 2010 to December 2013, and the cases were divided into success group （n = 117） and non-success group （n --70） according to NIPPV treatment results. Univariate and Logistic regression analysis were conducted on clinical data. Results In this study, NIPPV treatment successful rate was 62.6% （117/187）. Compared with that before therapy, PaCO2 value declined significantly one hour after therapy in success group （ t = 9. 1079, P 〈 0.01 ）, but it was not obviously different after therapy in non-success group （ t = 1. 8167, P 〉0.05 ）. Univariate analysis showed that the influencing factors of NIPPV efficacy were PaCO2 value one hour after therapy （t = -6.295, P〈0.05）, APACHE 11 score （t = -6.443, P〈0.05）, respiratory index （t=1.229, P〈0.05）, PaCO2 value before treatment （ t = - 2. 122, P 〈 0.05 ）, neurogenic pulmonary edema （X2 = 6. 869, P 〈 0.05 ） and interstitial lung disease （X2 = 5. 485, P 〈 0. 05 ）. Multivariate Logistic regression analysis showed that treatment results were correlated with PaCO2 value one hour after therapy （95% CI：0. 845 - 0. 958）, APACHE Ⅱ score （95 % CI：0. 281 - 0. 711 ）, respiratory index （95% CI： 0. 001 - 0. 323 ） and neurogenic pulmonary edema （95 % C1：4. 137 -6107. 726） with statistical significance （all P 〈 0. 05 ）. Conclusion In the implementation of NIPPV for children with ARF, risk factors affecting therapeutic efficacy should be avoided or timely treated, which can improve the successful rate of therapy.