慢性阻塞性肺疾病急性加重病人机械通气后经鼻高流量氧疗失败的危险因素分析

Risk factors for the failure in transnasal high-flow oxygen therapy in patients with AECOPD after mechanical ventilation

目的分析慢性阻塞性肺疾病急性加重(AECOPD)病人机械通气后经鼻高流量氧疗失败的危险因素。方法收集晋江市医院2019年5月至2020年5月收治的100例AECOPD病人的临床资料,根据治疗情况分为治疗成功组和治疗失败组。比较两组性别、年龄、重症肺炎史、呼吸衰竭史、气管插管史、机械通气时间、住院时间、住重症监护病房(ICU)时间、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)评分及血清脑钠肽(BNP)、pH、氧合指数(PaO_(2)/FiO_(2))等。采用受试者操作特征曲线(ROC曲线)分析SOFA、BNP、pH对AECOPD病人机械通气后经鼻高流量氧疗失败的预测价值;多因素logistic回归分析AECOPD病人机械通气后经鼻高流量氧疗失败的危险因素;通过一致性分析各危险因素联合预测AECOPD病人机械通气后经鼻高流量氧疗失败的价值。结果两组性别、年龄、呼吸衰竭史、气管插管史、机械通气时间、住院时间、住ICU时间、APACHEⅡ、PaO_(2)/FiO_(2)比较,差异无统计学意义(P>0.05);治疗失败组重症肺炎史占比显著高于治疗成功组(20.00%比3.75%),SOFA[(7.62±3.77)分比(4.51±2.33)分]、BNP[(281.12±203.45)ng/L比(138.94±98.73)ng/L]显著高于治疗成功组,pH显著低于治疗成功组[(7.29±0.25)比(7.38±0.37)],差异有统计学意义(P<0.05);经ROC和logistic分析,SOFA≥5.49分、BNP≥222.15 ng/L、pH≤7.32、重症肺炎是AECOPD病人机械通气后经鼻高流量氧疗失败的危险因素(P<0.05);经一致性分析,各危险因素联合预测AECOPD病人机械通气后经鼻高流量氧疗失败的灵敏度为0.95,特异度为0.99,准确率为0.98,Kappa=0.94。结论APACHEⅡ、SOFA评分及血清BNP与AECOPD病人机械通气后经鼻高流量氧疗失败具有一定相关性,联合各项指标的预测价值更好。

Objective To analyze the risk factors for the failure in transnasal hyperflow oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)after mechanical ventilation.Methods The clinical data of 100 AECOPD patients admitted to Jinjiang Hospital from May 2019 to May 2020 were collected and assigned into two groups:treatment success group and treatment failure group according to the treatment outcome.A comparison was made between the two groups in gender,age,history of severe pneumonia,history of respiratory failure,history of tracheal intubation,mechanical ventilation time,hospital stay,length of stay in intensive care unit(ICU),acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)score,serum brain natriuretic peptide(BNP),pH,oxygenation index(PaO_(2)/FiO_(2)).Receiver operating characteristic(ROC)curve was adopted to analyze the value of SOFA,BNP and pH in predicting the failure in transnasal high-flow oxygen therapy in patients with AECOPD after mechanical ventilation.The risk factors for the failure were determined by multivariate logistic regression analysis.The value of combined risk factors for predicting the failure was analyzed by consistency analysis.Results There were no significant differences in gender,age,history of respiratory failure,history of tracheal intubation,mechanical ventilation time,hospital stay,ICU stay,APACHEⅡ,and PaO_(2)/FiO_(2) between the two groups(P>0.05).The proportion of severe pneumonia in the treatment failure group was significantly higher than that of the treatment success group(20.00%vs.3.75%),SOFA[(7.62±3.77)vs.(4.51±2.33)]and BNP[(281.12±203.45)ng/L vs.(138.94±98.73)ng/L]in the treatment failure group were significantly higher than those in the treatment success group,while the pH was significantly lower in the treatment failure group than the treatment success group[(7.29±0.25)vs.(7.38±0.37)];the difference was statistically significant(P<0.05).ROC and logistic analysis results showed that SOFA≥5.49 points,BNP≥222.15 ng/L,pH≤7.32,and severe pneumonia were risk factors for the failure in transnasal high-flow oxygen therapy after mechanical ventilation in AECOPD patients(P<0.05).Consistency analysis results showed that the combined risk factors had a sensitivity of 0.95,a specificity of 0.99,an accuracy of 0.98,and a Kappa=0.94 to predict the failure.Conclusion APACHEⅡ,SOFA score and serum BNP have a certain correlation with the failure in transnasal high-flow oxygen therapy after mechanical ventilation in AECOPD patients,and the combined indicators had better predictive value.