无创正压通气治疗慢性阻塞性肺疾病急性加重失败的危险因素研究

Study on risk factors for noninvasive positive pressure ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease

目的探讨无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重(AECOPD)失败的危险因素。方法 162例接受无创正压通气治疗的慢性阻塞性肺疾病急性加重患者,根据无创正压通气治疗结果分为成功组(127例)与失败组(35例)。比较两组入院时年龄;入院时和无创正压通气治疗1 h及3 h后生命体征:呼吸频率(RR)、心率(HR),动脉血气[pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)]指标。结果 162例患者中有127例成功(78.4%),男∶女=96∶31;5例失败(21.6%),男∶女=29∶6;两组患者性别比较,差异无统计学意义(P>0.05)。治疗1、3 h后,成功组RR、HR均低于失败组,差异均具有统计学意义(P<0.05)。成功组治疗1、3 h后的RR,治疗3 h后的HR均低于本组治疗前,失败组治疗3 h后的RR,治疗1、3 h后的HR均高于本组治疗前,差异均具有统计学意义(P<0.05)。失败组治疗3 h后的RR高于本组治疗1 h后,成功组治疗3 h后的HR低于本组治疗1 h后,差异均具有统计学意义(P<0.05)。治疗1 h后:成功组pH值、PaO2、PaO2/FiO2均高于失败组,差异均具有统计学意义(P<0.05)。治疗3 h后:成功组pH值、PaO2、PaO2/FiO2高于失败组, PaCO2低于失败组,差异均具有统计学意义(P<0.05)。治疗1、3 h后与治疗前比较:成功组pH值、PaO2、PaCO2、PaO2/FiO2均较本组治疗前改善,差异均具有统计学意义(P<0.05)。失败组PaO2较本组治疗前改善,差异具有统计学意义(P<0.05)。治疗3 h后与治疗1 h后比较:成功组治疗3 h后PaCO2低于本组治疗1 h后,差异具有统计学意义(P<0.05)。结论患者无创正压通气治疗1~3 h后呼吸过速、心动过速、氧合状态、高碳酸血症、酸中毒无明显动态改善是无创正压通气治疗慢性阻塞性肺疾病急性加重失败的可能危险因素。

Objective To investigate the risk factors of failure for noninvasive positive pressure ventilation（NPPV） in the treatment of acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods A total of 162 patients with acute exacerbation of chronic obstructive pulmonary disease treated by noninvasive positive pressure ventilation were divided by results of noninvasive positive pressure ventilation into success group（127 cases） and failure group（35 cases）. Comparison were made on age, smoking status, gender, body mass index（BMI）, modified British Medical Research Council（mMRC） classification, Glasgow Coma Scale（GCS） scores at admission, vital signs at admission and 1 and 3 hours after noninvasive positive pressure ventilation： respiratory rate（RR）, heart rate（HR）, arterial blood gas [pH value, arterial partial pressure of oxygen（PaO2）, arterial partial pressure of carbon dioxide（PaCO2）, oxygenation index（PaO2/FiO2）]. Results Of the 162 patients, there were 127 successful cases（78.4%） and 35 failed cases（21.6%）. There was no statistically significant difference in gender, age, smoking status, BMI, mMRC grading and GCS score（P〈0.05）. After 1 and 3 h of treatment, success group had lower RR and HR than the failure group, and the difference was statistically significant（P〈0.05）. The success group had lower RR after 1 and 3 h of treatment, and HR after 3 h of treatment than those before treatment. The failure group had higher RR after 3 h of treatment, and HR after 1 and 3 h of treatment than those before treatment. Their difference was statistically significant（P〈0.05）. The failure group had higher RR after 3 h of treatment than that after 1 h of treatment, and the success group had lower HR after 3 h of treatment than that after 1 h of treatment. Their difference was statistically significant（P〈0.05）. After 1 h of treatment： the success group had higher pH value, PaO2 and PaO2/FiO2 than failure group, and the difference was statistically significant（P〈0.05）. After 3 h of treatment： the success group had higher pH value, PaO2 and PaO2/FiO2 than failure group, and lower PaCO2 than failure group. Their difference was statistically significant（P〈0.05）. After 1 and 3 h of treatment, the pH value, PaO2, PaCO2 and PaO2/FiO2 in the successful group were improved compared with those before treatment, and the difference was statistically significant（P〈0.05）. PaO2 in failure group was improved compared with those before treatment, and the difference was statistically significant（P〈0.05）. The success group had lower PaCO2 after 3 h of treatment than that after 1 h of treatment, and the difference was statistically significant（P〈0.05）. Conclusion Tachypnea, tachycardia, oxygenation, hypercapnia and acidosis without significant dynamic improvement after 1~3 h of noninvasive positive pressure ventilation are the possible risk factors for failure of noninvasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease with acute exacerbation.