AECOPD合并呼吸衰竭患者无创通气依从性影响因素分析

Analysis on influencing factors of non-invasive ventilation treatment compliance in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure

目的评价慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者无创通气(NIV)治疗依从性,分析NIV治疗依从性的影响因素。方法选取2019年7月—2020年6月遵义医科大学第五附属(珠海)医院收治的AECOPD合并呼吸衰竭住院患者为研究对象,对他们进行规范的NIV治疗,根据治疗依从性将患者分为依从性良好组(A组)与依从性差组(B组),收集临床相关资料,对数据进行单因素分析,单因素分析有意义的临床数据再纳入多因素分析,探讨NIV治疗依从性的影响因素。结果共纳入92例患者,其中A组58例、B组34例,NIV依从性差发生率为36.96%。将临床数据采用t检验、Wilcoxon秩和检验或者χ^(2)检验进行单因素分析,首次连续NIV治疗、PaCO_(2)、CAT评分、mMRC分级、HADS(A)有统计学差异(P<0.15)。经Logistic回归分析,PaCO_(2)>63.5 mmHg(OR=0.174,95%CI:0.047~0.642)、首次连续NIV治疗(OR=0.015,95%CI:0.002~0.103)、CAT评分>23.5分(OR=0.106,95%CI:0.019~0.597)是依从性良好的保护因素(P<0.05),HADS(A)>13.5分(OR=15,95%CI:3.401~66.162)为依从性差的独立危险因素(P<0.05)。结论较高PaCO_(2)、首次连续NIV治疗、较高CAT评分是NIV治疗依从性良好的预测因素,焦虑是NIV治疗依从性差的预测因素,临床应重视减轻焦虑及改善首次NIV治疗体验。

Objective To evaluate non-invasive ventilation(NIV)treatment compliance in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)accompanied with respiratory failure,and to analyze the risk factors of poor NIV treatment compliance.Methods AECOPD patients from the Fifth Affiliated Hospital of Zunyi Medical University(zhuhai)accompanied with respiratory failure were given standardized NIV treatment and divided into good compliance group(group A)and poor compliance group(group B)according to treatment compliance,who hospitalized from July 2019 to June 2020 were selected.The relevant clinical data were collected,and the data were analyzed by univariate analysis.The significant clinical data in univariate analysis were then included in multivariate analysis to explore the influencing factors of NIV treatment compliance.Results A total of 92 patients were enrolled,including 58 in group A and 34 in group B.The incidence of poor compliance in NIV was 36.96%.Univariate analysis of clinical data was performed using t test,Wilcoxon rank-sum test,or Chi-square test.There were differences in successive NIV in the first time,PaCO_(2),CAT score,mMRC classification and HADS(A)in single factor screening between the two groups(P<0.15).Logistic regression analysis showed that PaCO_(2)>63.5 mmHg(OR=0.174,95%CI:0.047~0.642),successive NIV in the first time(OR=0.015,95%CI:0.002~0.103)and CAT>23.5(OR=0.106,95%CI:0.019~0.597)were protective factors for good NIV treatment compliance(P<0.05),and HADS(A)>13.5 score(OR=15,95%CI:3.401~66.162)was a risk factor for poor NIV treatment compliance(P<0.05).Conclusion High PaCO_(2),successive NIV in the first time and high CAT score were protective factors for good NIV treatment compliance,while anxiety was predictive factor for poor NIV treatment compliance.Clinical attention should be paid to reducing anxiety and improving the first NIV treatment experience.