非HIV肺孢子菌肺炎伴急性呼吸衰竭患者无创机械通气失败的影响因素分析

Influence Factors for Noninvasive Ventilation Failure in Acute Respiratory Failure with Pneumocystis Jirovecii Pneumonia in Patients without HIV Infection

【目的】探讨非HIV肺孢子菌肺炎(NH-PJP)伴急性呼吸衰竭(ARF)患者无创机械通气(NIV)失败的影响因素。【方法】选取2019年1月至2021年12月本院呼吸重症监护室(RICU)收治的NH-PJP伴ARF患者,收集患者一般资料、免疫抑制剂使用情况、临床症状、实验室检查、NIV使用情况、住院时间和预后等相关指标,分析NIV失败的影响因素。【结果】本研究共纳入38例患者,其中27例(71.05%)NIV失败。NIV失败组动脉血氧分压/氧浓度(PaO_(2)/FiO_(2))在NIV后1 h和24 h显著低于NIV成功组(P<0.05)。NIV失败组患者在NIV起始时的急性生理和慢性健康评分(APACHEⅡ)明显高于NIV成功组(P<0.05)。NIV起始时的APACHEⅡ和NIV 24 h的PaO_(2)/FiO_(2)是NIV失败的危险因素。NIV失败与住院期间死亡率显著相关(P<0.05)。【结论】NIV时APACHEⅡ和NIV 24 h的PaO_(2)/FiO_(2)可作为NH-PJP患者NIV失败的预测指标,且NIV治疗失败的NH-PJP患者死亡率高。

【Objective】To investigate the influencing factors of non-invasive mechanical ventilation(NIV)failure in acute respiratory failure(ARF)patients with non-HIV pneumococcal Jirovecii pneumonia(NH-PJP).【Methods】Retrospective analysis was performed on all patients with ARF caused by NH-PJP(non-NIV pneumococcal Jirovecii pneumonia)from January 2019 to December 2021 in our hospital.General data,immunosuppressant use,clinical symptoms,laboratory tests,NIV use,length of hospital stay and prognosis were collected to analyze the influencing factors of NIV failure.【Results】A total of 38 eligible patients were collected in the study and NIV failed in 27 patients(71.05%).At 1 h and 24 h after NIV,the PaO_(2)/FiO_(2) in NIV failure group was significantly lower than that in NIV success group.The acute physiology and chronic health(APACHEⅡ)score of patients in the NIV failure group was significantly higher than that in the NIV success group.In multivariate analysis showed that APACHEⅡat the beginning of NIV and PaO_(2)/FiO_(2) at 24 h after NIV were risk factors for NIV failure.NIV failure was significantly associated with hospital mortality(P<0.05).【Conclusion】APACHEⅡscore and PaO_(2)/FiO_(2) at 24 h after NIV might predict NIV failure in NH-PJP patients,and the mortality rate was high in NH-PJP patients with NIV failure.