无创正压通气治疗脓毒症所致急性呼吸窘迫综合征的疗效观察

Therapeutic Effect of Noninvasive Positive Pressure Ventilation on Acute Respiratory Distress Syndrome Induced by Sepsis

目的观察无创正压通气(NPPV)治疗脓毒症所致急性呼吸窘迫综合征(ARDS)的临床疗效,探讨影响其疗效的相关因素。方法搜集并分析2012年1月1日至2016年12月31日期间四川省人民医院各ICU因脓毒症致ARDS并接受NPPV治疗的82例患者的临床资料,筛选对疗效存在影响的相关因素。结果 NPPV成功组的序贯器官衰竭评分(SOFA)与血清C反应蛋白(CRP)、降钙素原(PCT)水平分别低于失败组各对应指标,血小板(PLT)计数高于失败组,差异有统计学意义(P<0.05);两组氧合指数(PaO_2/FiO_2)是否大于150mmHg、是否转为有创正压通气(IPPV),差异有统计学意义(P<0.05);SOFA评分<10分、氧合指数≥150mmHg、Plt≥50×10~9/L与NPPV疗效相关。结论 NPPV治疗脓毒症所致的ARDS有一定的应用价值,当患者的SOFA评分<10分、氧合指数≥150mmHg、Plt≥50×10~9/L时,成功率更高。

Objective To observe the clinical efficacy of noninvasive positive pressure ventilation（NPPV） in the treatment of sepsis-induced acute respiratory distress syndrome（ ARDS） and to explore the factors that affect its efficacy. Methods We collected and analyzed the clinical data of 82 patients receiving NPPV in ICU with ARDS caused by sepsis from January 1,2012 to December 31,2016 and screened the relevant factors. Results The sequential organ falure assessment （SOFA） score serum C-reactive protein（ CRP） and procalcitonin（PCT） were significantly lower in the NPPV successful group than those in the failed group, and the platelet （Pit） count was higher than that of the failure group. The difference was statistically significant （ P 〈 0. 05 ）. The difference of whether the oxygenation index（ PaO2/FiO2 ）of the two groups was greater than 150mmHg and whether invasive positive pressure ventilation（IPPV） was used in the two groups was statistically significant（ P 〈 O. 05 ） ;SOFA score 〈 10 points, oxygenation index ≥ 150mmHg and Plt≥50 ×10^9/L were influence factors of NPPV efficacy. Conclusion NPPV has a certain val- ue in treatment of sepsis caused by ARDS, and the success rate is higher when the patient＇s SOFA score 〈 10 points, oxygenation index ≥150mmHg and Plt≥50 × 10^9/L.