无创正压通气治疗不同病因所致急性呼吸衰竭的疗效与安全性研究

Efficacy and safety of noninvasive positive pressure ventilation in the treatment of acute respiratory failure due to different etiologies

目的:探讨无创正压通气(NPPV)对不同病因所致急性呼吸衰竭的疗效与安全性及影响疗效的因素。方法:采用回顾性分析方法,选择2010年1月至2015年12月,入住北京安贞医院呼吸与危重症医学科重症监护室(RICU)的所有诊断为急性呼吸衰竭,经常规氧疗后症状无好转或加重并给予NPPV治疗的患者,并按引起呼吸衰竭的病因分为慢性阻塞性肺疾病组(COPD组)和非COPD组。收集患者的一般情况,包括性别、年龄、APACHE II评分、HGB及白蛋白,记录使用NPPV前、1h后、2~4h的心率、呼吸频率及血气分析测值(pH,PaO_2,PaCO_2,SaO_2),比较各组患者的再插管率、病死率、住重症监护室(RICU)时间。结果:研究期间,共有252例各种类型的呼吸衰竭患者入住RICU,符合研究纳入标准的患者123例(48.8%),男性69例,女性54例,平均年龄(71.0±11.6)岁。其中COPD组79例,非COPD组44例。COPD组APACHE II评分(20.9±4.4)和PaCO_2(73.4±14.0)mm Hg(1mm Hg=0.133KPa),显著高于非COPD组[分别为(18.4±4.6)和(65.9±14.0)mm Hg],呼吸频率[(21.1±4.5)次/min、心率(88.1±17.4)次/min低于非COPD组(分别为(24.9±7.6)次/min、(95.6±19.5)次/min,P<0.05],两组间平均动脉压、pH值、PaO_2和Sa O2差异无统计学意义。NPPV治疗1h、2~4h后两组的pH、PaCO_2和PaO_2均显著改善,心率和呼吸频率减慢(P<0.05或P<0.01)。COPD组再插管率为5.1%,住院病死率5.1%,均明显低于非COPD组(分别为15.9%和27.3%)(P<0.05或P<0.01)。COPD组的成功率为89.9%,显著高于其他病因组的72.7%(P<0.05)。两组住RICU时间相近(分别为15d vs.16d,P>0.05)。结论:NPPV选择性用于COPD所致急性呼吸衰竭患者,可显著降低再插管率,改善患者的预后,疗效优于非COPD所致急性呼吸衰竭患者,且并发症产生少,安全性较好。

Objective：To evaluate the efficacy and safety of noninvasive positive pressure ventilation （NPPV） due to different etiologies. Methods： Selected acute respiratory failure （ARF） patients from January 2010 to December 2015. The patients were further classified into two groups based on the etiology of ARF as COPD-ARF and ARF due to other causes. Data were gathered on sex, age, APACHE II score, vital sign,arte- rial blood gases （ pH, partial pressure of oxygen in the arterial blood [ PaO2 ], partial pressure of carbon dioxide in arterial blood [ PaCO2 ] ） at baseline, one and two-four hours. Re-intubation rates, mortality rates and RICU stay were compared. Results： During the year of study, 123 patients （69 were male and 54 were female with a mean age of （71.0 ± 11.6） years were enrolled, COPD-ARF group had 79 patients and ARF due to other cau- ses 44 patients. COPD-ARF group had significantly（P 〈 0. 05 or P 〈 0. 01 ）lower re-intubation rate （5.1% ）, hospital mortality （5.1%）as compared with ARF due to other causes （15.9% and 27.3% respectively）.COPD-ARF group had higher success rate（89. 9% ） than ARF due to other causes（72. 7%）. There was no difference in the RICU stay（ 15d VS 16d,P 〉 0.05 ）. The heart rate,respiratory rate and arterial blood gas anal- ysis values（ pH, PaC02 and PaO2 ）were significantly improved as compared with baseline values after lh,2-4 h of NPPV therapy, and there were no significant between--groups differences either at baseline, l h or 2-4 h of treat- ment. Conclusion： Our study indicates that NPPV is more effective in preventing endotracheal intubation in ARF due to COPD than other causes.