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目的探讨影响无创正压通气治疗慢性阻塞性肺疾病伴呼吸衰竭疗效的相关因素。方法回顾性分析无创通气治疗的慢性阻塞性肺疾病伴呼吸衰竭患者40例,按照治疗效果患者分为无创通气治疗成功组和无创通气治疗失败组。以临床上常用的各项生理学指标为基础,对无创通气治疗成功和失败的患者进行Logistic多元回归分析,寻找无创通气失败的高危因素。结果本组NIPPV治疗成功率为78.10%。NIPPV失败组入院初PaO2、pH、BP、白蛋白及ADL记分明显低于NIPPV成功组(P<0.05),而年龄、COPD病史、APACHE II评分、PaCO2、WBC计数、血糖、肌酐及入院时存在的并发症发生率均明显高于NIPPV成功组(P<0.05),其余指标两组间差异无统计学意义;Logistic逐步回归多因素分析显示入院初APACHE II评分、pH、PaO2及PaCO2是导致NIPPV治疗失败的独立相关因素。结论患者治疗前的A-PACHEⅡ评分、动脉血pH值及PaO2及PaCO2是影响无创正压通气疗效的独立危险因素。
Objective To explore the factors influencing the curative effect of noninvasive positive pressure ventilation on chronic obstructive pulmonary disease with respiratory failure. Methods Forty patients with chronic obstructive pulmonary disease and respiratory failure who underwent noninvasive ventilation were retrospectively analyzed. According to the therapeutic effect, the patients were divided into the non-invasive ventilation group and the noninvasive ventilation group. Based on the physiological indexes commonly used clinically, Logistic multivariate regression analysis was performed on patients who succeeded and failed in non-invasive ventilation to find out the risk factors of noninvasive ventilatory failure. Results The success rate of NIPPV treatment in this group was 78.10%. The scores of PaO2, pH, BP, albumin and ADL in the NIPPV failure group were significantly lower than those in the NIPPV success group (P <0.05), while the age, COPD history, APACHE II score, PaCO2, WBC count, (P <0.05). There was no significant difference between the two groups in other indexes. Logistic regression analysis showed that APACHE II score, pH, PaO2 and PaCO2 at admission were the main causes of NIPPV Independent correlates of treatment failure. Conclusions The A-PACHEⅡscore, arterial blood pH, PaO2 and PaCO2 before treatment are independent risk factors for noninvasive positive pressure ventilation.