急性高碳酸血症呼吸衰竭老年患者无创通气治疗失败风险评估模型研究

A risk assessment model for failure of noninvasive ventilation in elderly patients with acute hypercapnia respiratory failure

目的探究急性高碳酸血症呼吸衰竭(AHRF)老年患者无创通气(NIV)治疗失败的高危因素,构建失败风险评估模型。方法回顾性分析2015年8月至2017年8月在北京医院因AHRF行NIV治疗的100例老年住院患者资料,应用Cox比例风险模型探究AHRF老年患者NIV治疗失败的危险因素并建立风险评估模型;根据模型对患者进行危险度分层,比较不同危险分层患者NIV治疗失败率的差异,并通过构建受试者工作特征曲线(ROC),评价模型预测价值。结果NIV治疗前心率≥120次/min、胸部X线片示病变浸润≥3个象限、合并重症肺炎和简化急性生理学评分Ⅱ(SAPSⅡ)≥34分是AHRF老年患者NIV治疗失败的独立危险因素(P<0.05)。NIV治疗失败风险指数=0.808X 1(心率≥120次/min)+1.067X 2(胸部X线片示病变浸润≥3个象限)+1.79X 3(合并重症肺炎)+0.675X 4(SAPSⅡ≥34分)。随着风险模型评分的增加,AHRF老年患者NIV治疗失败率显著增加(P<0.001)。该模型ROC曲线下面积为0.882(95%CI:0.817~0.948,P<0.001)。结论NIV治疗前心率≥120次/min、胸部X线片示病变浸润≥3个象限、合并重症肺炎和SAPSⅡ≥34分是AHRF老年患者NIV治疗失败的独立危险因素,失败风险评估模型预测效能良好。

Objective To identify risk factors for failure of noninvasive ventilation(NIV)in elderly patients with acute hypercapnia respiratory failure(AHRF)and develop a predict model of the failure.Methods Retrospective analysis was performed on the data of 100 elderly inpatients who received NIV treatment for AHRF in Beijing hospital from August 2015 to August 2017.Cox proportional hazards model was used to identify risk factors and establish a risk assessment model.The differences in the failure rate of NIV treatment among patients with different risk stratification were compared,and the model was evaluated by receiver operating characteristic curve(ROC).Results Before NIV treatment,Heart rates≥120 beats/min,Chest X-ray for lesion infiltration≥3 quadrants,severe pneumonia and SAPSⅡscores≥34 are independent risk factors for failure of NIV treatment in elderly patients with AHRF(P<0.05).NIV treatment failure risk index=0.808X 1(Heart rates≥120 beats/min)+1.067X 2(Chest X-ray for lesion infiltration≥3 quadrants)+1.79X 3(severe pneumonia)+0.675X 4(SAPSⅡscore≥34 points).With the increase of risk index,the incident of NIV treatment failure in elderly patients with AHRF increased significantly(P<0.001).The area under the ROC curve of this model was 0.882(95%CI 0.817~0.948,P<0.001).Conclusion Heart rates≥120 beats/min before NIV treatment,Chest X-ray for lesion infiltration≥3 quadrants,severe pneumonia and SAPSⅡscore≥34 points are independent risk factors for failure of NIV treatment in elderly patients with AHRF.The predict model is reliable in predicting failure of NIV in elderly patients with AHRF.