无创正压通气治疗COPD并急性高碳酸血症呼吸衰竭患者的早期影响因素分析

Effect of the early outcome on NIV for COPD patients with acute hypercapnia respiratory failure

目的探讨无创正压通气(NIV)对慢性阻塞性肺疾病(COPD)并急性高碳酸血症呼吸衰竭患者早期治疗结局的影响因素。方法研究纳入2015年1月-2018年12月在扬州大学附属医院接受NIV治疗的COPD并急性高碳酸血症呼吸衰竭患者124例。将所有患者依据早期NIV治疗后1 h结局分为2组,其中NIV治疗成功患者113例(试验组),早期NIV治疗失败患者11例(对照组),分析2组患者NIV治疗前后基本特征差异,采用Logistic回归分析影响患者NIV治疗结局的因素。结果2组患者在NIV治疗前的急性生理与慢性健康评分(APACHE II)、心率以及pH上差异有统计学意义(P<0.05)。2组患者在NIV治疗后1 h,其心率和pH差异有统计学意义(P<0.05)。NIV治疗前和治疗后患者的心率和pH均是影响NIV治疗结局的重要影响因素,差异具有统计学意义(P<0.05)。在NIV治疗前,患者心率<120次/min,且pH>7.29,NIV失败的比例最小,为3.33%,而无论是NIV治疗前,还是NIV治疗1 h后,在患者心率>120次/min,且pH<7.25,NIV失败的比例最大,高达50.00%。结论COPD并急性高碳酸血症呼吸衰竭患者存在心动过速和严重酸中毒现象是NIV早期治疗结局的重要影响因素,可作为临床预测因子。

ObjectiveOnto analyze the influencing factors of the outcome of NIV for patients with chronic obstructive pulmonary disease(COPD)and acute hypercapnic respiratory failure.MethodsIncluded were 124 patients with COPD and acute hypercapnia respiratory failure who underwent NIV treatment at the Yangzhou University Affiliated Hospital from January 2015 to December 2018.All patients were divided into 2 groups according to the 1 h outcome after early NIV treatment,including 113 patients with NIV treatment(test group)and 11 patients with early NIV treatment failure(control group).The differences of basic characteristics before and after NIV treatment in 2 groups were analyzed.Logistic regression was used to analyze the factors affecting the outcome of NIV treatment in patients.ResultsThere were significant differences in APACHE II score,heart rate and pH between the two groups before NIV treatment(P<0.05).There was a significant difference in heart rate and pH between the two groups at 1 h after NIV treatment(P<0.05).Heart rate and pH of patients before and after NIV treatment were important factors influencing the outcome of NIV treatment,and the difference was statistically significant(P<0.05).Before NIV treatment,the proportion of NIV failure was the smallest(3.33%),when the patient′s heart rate was<120 beats/min,and the pH was>7.29.Before NIV treatment or 1 hour after NIV treatment,the pH<7.25,the heart rate was>120 beats/min.,the largest proportion of NIV failure,up to 50.00%.ConclusionRapid heartbeat and severe acidosis phenomenon were shown to be the two important factors affecting the NIV treatment outcome in patients with COPD and acute hypercapnia respiratory failure,which could be used as predictors.