慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者无创正压通气治疗成功的预测因素分析

Predictive Factors for the Success of Noninvasive Positive Pressure Ventilation in Treatment of Patients with Chronic Obstructive Pulmonary Disease Combined with Type Ⅱ Respiratory Failure

目的分析慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者应用无创正压通气(NIPPV)治疗成功的预测因素。方法选取2017年9月—2020年9月本院收治的128例COPD合并Ⅱ型呼吸衰竭患者,根据NIPPV治疗是否成功分为成功组90例和失败组38例。比较2组入院时心率、呼吸频率、血氧饱和度、平均动脉压、急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,入院第1日血生化及免疫指标,治疗前及治疗2、4 h后血气分析结果。通过Logistic回归模型分析COPD合并Ⅱ型呼吸衰竭患者NIPPV治疗成功的影响因素;采用受试者工作特征(ROC)曲线分析相关危险因素对COPD合并Ⅱ型呼吸衰竭患者NIPPV治疗成功的预测价值。结果成功组入院第1日CD4+、CD8+、CD3+水平高于失败组,APACHEⅡ评分低于失败组,差异有统计学意义(P<0.01);成功组治疗4 h后pH值、脉搏二氧化碳分压(PaCO_(2))较对照组低(P<0.05或P<0.01)。多因素Logistic回归分析显示:入院时高APACHEⅡ评分及治疗4 h后pH值、PaCO_(2)未改善是COPD合并Ⅱ型呼吸衰竭患者NIPPV治疗成功的独立危险因素(P<0.05或P<0.01)。ROC曲线分析显示,入院时APACHEⅡ评分及治疗4 h后pH值、PaCO_(2)联合检测曲线下面积最大,为0.960。结论入院时高APACHEⅡ评分及治疗4 h后pH值、PaCO_(2)未改善是影响COPD合并Ⅱ型呼吸衰竭患者NIPPV治疗成功的独立危险因素,联合检测患者入院时APACHEⅡ评分及治疗4 h后动脉血气分析结果可提高NIPPV治疗成功的预测价值。对伴有上述危险因素患者临床需加强干预,进而提高NIPPV治疗成功率。

Objective To analyze predictive factors for the success of noninvasive positive pressure ventilation(NIPPV)in treatment of patients with chronic obstructive pulmonary disease(COPD)combined with typeⅡrespiratory failure.Methods A total of 128 patients with COPD complicated with typeⅡrespiratory failure admitted during September 2017 to September 2020 were selected and divided into success group(n=90)and failure group(n=38)according to whether or not success of NIPPV treatment.Values of heart rate(HR),respiratory rate(RR),blood oxygen saturation,mean arterial pressure(MAP),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score at the time of admission,blood biochemical and immune indexes on the 1 st d after admission,and results of blood gas analysis before,and at the 2 nd h and 4 th h after treatment were compared between two groups.Logistic regression model was used to analyze influencing factors for the success of NIPPV in treatment of COPD patients with typeⅡrespiratory failure.Receiver operating characteristic(ROC)curve was used to analyze predictive value of related risk factors in the success of NIPPV in treatment of COPD patients with typeⅡrespiratory failure.Results On the 1 st d after admission in success group,levels of CD4+,CD8+and CD3+were significantly higher than those in failure group,while APACHEⅡscore was significantly lower than that in failure group(P<0.01).At the 4 th h after treatment,Values of pH and PaCO_(2) in success group were significantly lower in success group than those in control group(P<0.05 or P<0.01).Multivariate Logistic regression analysis showed that high APACHEⅡscore at the time of admission,and no improvements of pH and PaCO_(2) values at 4 th h after treatment were independent risk factors for the success of NIPPV in treatment of COPD patients with typeⅡrespiratory failure(P<0.05 or P<0.01).ROC curve analysis showed that the area under ROC curve of combined detection of APACHEⅡscore at the time of admission and pH and PaCO_(2) values at the 4 th h after treatment was the largest(0.960).Conclusion High APACHEⅡscore at the time of admission and no improvements of pH and PaCO_(2) values at the 4 th after treatment are independent risk factors influencing the success of NIPPV in treatment of COPD patients with typeⅡrespiratory failure.Combined detection of APACHEⅡscore at the time of admission and results of arterial blood gas analysis at the 4 th h after treatment may improve predictive value in the success of NIPPV treatment.Patients with the above risk factors should be strengthened the intervention in order to improve the success rate of NIPPV treatment in clinic.