无创正压通气时长对Ⅱ型呼吸衰竭病因的鉴别诊断价值

The Differential Diagnostic Value of Duration of Non-invasive Positive Pressure Ventilation for Etiology of Type II Respiratory Failure

目的 分析无创正压通气(NIPPV)治疗急性心源性肺水肿(ACPE)和慢性阻塞性肺疾病急性加重期(AECOPD)所致Ⅱ型呼吸衰竭的疗效,并评估NIPPV时长对上述两种病因的鉴别效能。方法 回顾性纳入2019年8月至2022年8月医院ICU收治的119例Ⅱ型呼吸衰竭患者(初始治疗即为NIPPV)。将研究对象根据最终诊断分为ACPE组(82例)和AECOPD组(37例),比较两组治疗后的好转率,进一步将病情好转的患者分为ACPE亚组(65例)和AECOPD亚组(17例),比较两亚组的NIPPV时长差异;采用受试者工作特征(ROC)曲线,分析NIPPV时长对Ⅱ型呼吸衰竭病因的鉴别效能。结果 ACPE组的治疗好转率高于AECOPD组,差异有统计学意义(P<0.05);ACPE亚组的NIPPV时长短于AECOPD亚组,差异有统计学意义(P<0.05);绘制ROC曲线显示,NIPPV时长对Ⅱ型呼吸衰竭病因具有一定的鉴别效能[AUC:0.776(95%CI:0.653~0.900)]。结论 与AECOPD相比,NIPPV对ACPE所致Ⅱ型呼吸衰竭的疗效更好,且时长更短。此外,NIPPV时长对Ⅱ型呼吸衰竭的病因具有一定鉴别效能,有利于后续治疗方案的调整。

Objective The efficacy of non-invasive positive pressure ventilation(NIPPV)in the treatment of type II respiratory failure caused by acute cardiogenic pulmonary edema(ACPE)and acute exacerbation of chronic obstructive pulmonary disease(AECOPD)was analyzed,and the effectiveness of NIPPV usage duration in distinguishing the two aforementioned causes was evaluated.Methods With the retrospective inclusion of 119 patients with type II respiratory failure(NIPPV as the initial treatment method)admitted to the ICU in the hospital from August 2019 to August 2022,the study subjects were divided into the ACPE group(82 cases)and the AECOPD group(37 cases)based on the final diagnosis,and the improvement rates after treatment were compared between the two groups.Furthermore,patients with improved conditions were divided into the ACPE sub-group(65 cases)and the AECOPD sub-group(17 cases),and the differences in NIPPV usage duration between the two subgroups were compared;With the use of the ROC curve,the efficacy of NIPPV in differentiating the etiology of type II respiratory failure was analyzed.Results The improvement rate of treatment in the ACPE group was higher than that in the AECOPD group,with a statistically significant difference(P<0.05);The usage duration of NIPPV in ACPE subgroup was higher than that in AECOPD subgroup,and the difference was statistically significant(P<0.05);The drawing of ROC curve showed that NIPPV duration was effective in differentiating the etiology of type II respiratory failure[AUC:0.776(95%CI:0.653~0.900)].Conclusion Compared with AECOPD,NIPPV is more effective in the treatment of type II respiratory failure caused by ACPE,and its use time is shorter.In addition,the duration of NIPPV has a certain differentiation effect on the etiology of type II respiratory failure,which is helpful for the adjustment of the follow-up treatment scheme.