AECOPD并高碳酸血症患者HFNC治疗失败原因分析

Analysis of the Causes of HFNC Treatment Failure in Patients with AECOPD and Hypercapnia

目的收集经鼻高流量氧疗(high-flow nasal cannula oxygen therapy,HFNC)治疗的慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重期(AECOPD)并高碳酸血症患者的资料,分析治疗失败的危险因素。方法选取AECOPD并高碳酸血症应用HFNC治疗的患者100例,按照最终治疗结果分为成功组(71例)和失败组(29例);对2组患者的临床资料进行分析,比较2组患者的一般情况及指标。对2组间单因素分析有统计学意义的指标进一步行多因素logistics回归,分析HFNC治疗失败的原因,并寻找差异变量的Cut-off值。结果2组患者年龄、性别、合并症构成比、COPD自我评估测试(CAT)评分、急性生理与慢性健康(APACHEⅡ)评分、白介素6、脑钠肽、pH值、动脉血氧分压(PaO_(2))比较,差异无统计学意义(P>0.05),动脉血二氧化碳分压(PaCO_(2))、ROX指数(SpO_(2)/FiO_(2)除以呼吸频率)、肺动脉/升主动脉直径比值比较,差异有统计学意义(P<0.05);进一步多变量回归分析,ROX指数(OR=17.342,P<0.01)、肺动脉/升主动脉直径比值(OR=0.000,P<0.05)、PaCO_(2)(OR=0.890,P<0.05),ROC曲线下ROX指数面积为0.931,依据ROC曲线筛选的最佳Cut-off值为4.85,肺动脉/升主动脉直径比值曲线下面积0.230,PaCO_(2)曲线下面积0.373,以上两指标因曲线下面积较小,准确性欠佳。结论ROX指数、PaCO_(2)、肺动脉/升主动脉直径比值是AECOPD并高碳酸血症患者HFNC治疗失败的独立危险因素,ROX指数比值<4.85,患者治疗失败率更高。

Objective To analyze the risk factors for treatment failure in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with hypercapnia treated with high-flow nasal cannula oxygen therapy(HFNC).Methods One hundred patients with AECOPD and hypercapnia were selected to be treated with HFNC,71 cases in the success group and 29 cases in the failure group according to the final treatment results.The clinical data of the two groups were analyzed and the general conditions and indicators of the two groups were compared.Further multi-factor logistic regression analysis was performed to analyze the causes of HFNC treatment failure and to find Cut-off values for the differential variables for those indicators that were statistically significant in the univariate analysis between the two groups.Results There were no statistically significant differences between the two groups in terms of age,gender,body mass(BMI),comorbidity composition ratio,COPD self-assessment test(CAT)score,acute physiological and chronic health(APACHEⅡ)score,interleukin 6,brain natriuretic peptide,pH,and arterial partial pressure of oxygen(PaO 2)(P>0.05).Arterial blood carbon dioxide partial pressure(PaCO 2),ROX index(ratio of SpO 2/FiO 2 to respiratory rate),and pulmonary artery/ascending aortic diameter ratio between the two groups were statistically significant(P<0.05).Further multivariate regression analysis showed that ROX index(OR=17.342,P<0.01),pulmonary artery/ascending aortic diameter(OR=0.000,P<0.05)and PaCO 2(OR=0.890,P<0.05)were all independent risk factors.The area under the ROC curve for the inspiratory frequency-oxygenation(ROX)index was 0.931 and the optimal Cut-off value based on the ROC curve was 4.85.The area under the pulmonary artery/ascending aortic diameter ratio and the PaCO 2 curve were 0.230 and 0.373 respectively,both of which were less accurate due to the small area under the curve.Conclusion ROX index,PaCO 2 and pulmonary artery/ascending aortic diameter ratio are independent risk factors for HFNC treatment failure in patients with AECOPD and hypercapnia,and patients with ROX index ratios<4.85 have a higher rate of treatment failure.