呼吸衰竭患者咳嗽能力与无创机械通气有效性的相关性

Association between cough strength and the efficacy of noninvasive mechanical ventilation in patients with respiratory failure

目的探索咳嗽能力强弱与无创机械通气有效性之间的关联。方法收集2016年1~12月以呼吸衰竭入住重庆医科大学附属第一医院呼吸内科监护室使用无创机械通气的患者。在使用无创机械通气前对患者进行咳嗽能力评估。根据患者咳嗽能力大小分为强、中等和差三组。结果本研究共纳入370例患者,其中咳嗽能力强308例,咳嗽能力中等43例,咳嗽能力差19例。咳嗽能力强的患者无创机械通气失败率为16.9%,而咳嗽能力中等和咳嗽能力差的患者无创机械通气失败率分别为23.3%和78.9%(P<0.01)。咳嗽能力强的患者院内死亡率为19.5%,而咳嗽能力中等和咳嗽能力差的患者院内死亡率分别为32.6%和84.2%(P<0.01)。多变量逻辑回归分析显示咳嗽能力差是无创机械通气失败(OR=20.99,95%CI:5.10~86.50,P<0.01)和院内死亡(OR=17.15,95%CI:4.28~68.66,P<0.01)的独立危险因素。结论咳嗽能力越差,无创机械通气失败率越高,院内死亡风险越大。

Objective To explore the association between cough strength and the efficacy of noninvasive mechanical ventilation.Methods This study was performed in Respiratory Intensive Care Unit of the First Affiliated Hospital of Chongqing Medical University from January to December 2016.Patients required noninvasive mechanical ventilation due to acute respiratory failure were enrolled.Before the use of noninvasive mechanical ventilation,cough strength was assessed,and it was classified to strong,moderate and weak cough.Results A total of 370 patients were enrolled.Among them,308 patients were strong cough,43 patients were moderate cough and 19 patients were weak cough.The noninvasive mechanical ventilation failure rate was 16.9% in patients with strong cough;but it was 23.3% and 78.9%in patients with moderate and weak cough,respectively（P〈0.01）.The hospital mortality was 19.5% in patients with strong cough,but it increased to 32.6% and 84.2% in patients with moderate and weak cough,respectively（P 0.01）.Weak cough was an independent risk factor for noninvasive mechanical ventilation failure（OR = 20.99,95%CI：5.10-86.50,P 0.01） and death in hospital（OR = 17.15,95%CI：4.28-68.66,P 0.01） respectively analyzed by multivariable logistic regression analysis.Conclusion Weak cough is associated with increased noninvasive mechanical ventilation failure and hospital mortality.