无创通气治疗慢性阻塞性肺疾病急性发作合并Ⅱ型呼吸衰竭的疗效及影响因素

Curative effect of non-invasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease patients with type Ⅱ respiratory failure and its influencing factors

目的观察无创通气对慢性阻塞性肺疾病(COPD)急性发作合并Ⅱ型呼吸衰竭的临床疗效并分析影响疗效的因素。方法选取茂名市电白区人民医院2014年1月至2016年12月收治的COPD急性发作合并Ⅱ型呼吸衰竭患者117例作为研究对象,按照治疗效果分为成功组(n=87)和失败组(n=30)。所有患者给予常规治疗的同时加用无创通气。比较两组患者治疗前后的心率(HR)、呼吸频率(RR)、氧分压(PaO_2)、二氧化碳分压(PaCO_2)的变化,观察治疗效果。对治疗成功和失败患者的影响因素进行Logistic回归分析,以了解无创通气治疗失败的因素。结果无创通气治疗前患者的HR、RR、PaO_2、PaCO_2分别为(119.12±9.35)次/min、(26.27±7.31)次/min、(54.28±9.16)mm Hg和(78.63±10.77)mm Hg,治疗后分别为(87.63±7.34)次/min、(16.76±5.24)次/min、(74.39±10.74)mm Hg和(54.09±6.85)mm Hg,治疗后各项指标均明显改善,差异均有统计学意义(P<0.05);失败组患者入院时Pa O_2和pH明显低于成功组,而年龄、APACHEⅡ评分、COPD病史、WBC计数、血糖、肌酐、PaCO_2以及并发症发生率均明显高于成功组,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,入院时APACHEⅡ评分、PaO_2、PaCO_2和pH值是导致无创通气治疗失败的独立危险因素(P<0.05)。结论无创正压通气治疗对COPD伴呼吸衰竭疗效确切,患者治疗前APACHEⅡ评分、pH、PaO_2及PaCO_2是影响无创正压通气疗效的独立危险因素。

Objective To investigate the clinical effect of non-invasive positive ventilation（NPPV） in the treatment of patients with chronic obstructive pulmonary disease（COPD） complicated with type Ⅱ respiratory failure and the factors affecting the results. Methods A total of 117 patients with acute exacerbation of COPD complicated with type Ⅱ respiratory failure treated in People＇s Hospital of Dianbai District of Maoming from January 2014 to December2016 were selected as the research subjects. The patients were divided into the successful group（n=87） and the failed group（n=30） according to therapeutic effects. All patients were given NPPV based on conventional treatment. The changes of heart rate（HR）, respiratory rate（RR）, oxygen partial pressure（PaO2） and partial pressure of carbon dioxide（PaCO2） before and after treatment were compared between the two groups. Logistic regression analysis was performed to identify the factors influencing the failure of NPPV. Results The HR, RR, PaO2, PaCO2 were（119.12±9.35） beats/min,（26.27±7.31） beats/min,（54.28±9.16） mm Hg and（78.63±10.77） mm Hg before treatment, and（87.63±7.34） beats/min,（16.76 ± 5.24） beats/min,（74.39 ± 10.74） mm Hg and（54.09 ± 6.85） mm Hg after treatment, which were significantly improved after treatment（P〈0.05）. PaO2 and pH at admission in the failed group were significantly lower than those in the successful group（P〈0.05）, and age, APACHE Ⅱ score, COPD history, white blood cell（WBC） count, blood glucose,creatinine, PaCO2 level and complication rate in the failed group were significantly higher than those in the successful group（P〈0.05）. Logistic regression analysis showed that APACHE Ⅱ score, PaO2, PaCO2 and pH were independent risk factors of the failure of NPPV treatment（P〈0.05）. Conclusion NPPV is effective in the treatment of COPD complicated with type Ⅱ respiratory failure. APACHE Ⅱ score, pH, PaO2 and PaCO2 are the independent factors that affecting the curative effect of NPPV.