无创性通气治疗慢性阻塞性肺疾病呼吸衰竭并发上消化道出血的因素探讨

Relevant factors of upper gastrointestinal hemorrhage in patients with acute respiratory failure due to acute exacerbation of chronic obstructive pulmonary diseases received mechanical ventilation via face masks

目的 探讨慢性阻塞性肺疾病 (COPD)呼吸衰竭患者经无创性面罩机械通气 (FMMV)治疗后上消化道出血的发生率 ;同时分析与上消化道出血有关的因素。方法 采用回顾性病例对照研究 ,选择 1998年 1月～ 2 0 0 2年 12月因COPD呼吸衰竭住院并采用FMMV治疗的患者 2 15例。FMMV后发生上消化道出血者 14例为病例组 ;未发生上消化道出血、与病例组匹配的患者 5 1例为对照组。结果 上消化道出血率为 6 5 % ( 14 / 2 15 ) ,病例组死亡率为 35 7% ( 5 / 14 ) ;对照组死亡率为 2 % ( 1/ 5 1)。在单因素检验中 ,pH≤ 7 2 (P =0 0 16 )、严重感染 (P =0 0 4 2 )、肺性脑病 (P =0 0 0 7)是导致上消化道出血的危险因素。将这 3项变量导入Logistic回归方程 ,显示pH≤ 7 2、存在严重感染是有独立作用的变量。结论 FMMV治疗COPD呼吸衰竭可降低上消化道出血的发生率。上消化道出血可能提示预后不良。严重酸中毒、严重感染是导致上消化道出血的危险因素。

Objective To study the contributing and protective factors of upper gastrointestinal hemorrhage after non-invasive positive pressure ventilation on patients with acute respiratory failure due to acute exacerbation of chronic obstructive pulmonary diseases(COPD).Methods All the information were collected from patient's admission records from Jan,1998 to Dec,2002.These patients suffered from acute respiratory failure with hypercapnia due to acute exacerbation of COPD were admitted and administered by FMMV.In 215 cases studied,14 cases were complicated with upper gastrointestinal hemorrhage (group A) while 51 cases were selected from the non-hemorrhage patients (group B) as control.The two groups were matched with age,sex,etc.Upper gastrointestinal hemorrhage was defined by hematemesis,hematochezia or nasogastric tube output.A special form was designed and 14 variables were collected and analyzed.Results The incidence of upper gastrointestinal hemorrhage was 6.5%(14/215).The mortality was 35.7% (5/14) in group A and 2% (1/51) in group B.By single factor test,pH≤7.2 (P=0.016),severe infections (P=0.042) and pulmonary encephalopathy (P=0.007) had statistically significant impact.And in the logistic regression analysis,pH≤7.2 and severe infection were two independent risk factors for upper gastrointestinal hemorrhage.Conclusions Our clinical analysis demonstrates that FMMV could reduce the incidence of upper gastrointestinal hemorrhage in patients with acute respiratory failure due to acute exacerbation of COPD. Severe acidosis and severe infections are risk factors for gastrointestinal hemorrhage which is predictive for poor prognosis.