无创通气治疗慢性阻塞性肺病急性加重疗效的影响因素

摘要

Objective To investigate the effect of non-invasive ventilation in treatment of type II respiratory failure in patients with AECOPD and its influencing factors. Methods From January 2015 to August 2017 in our hospital, 237 AECOPD patients with type II respiratory failure who had been treated with non-invasive ventilation were selected as the research objects. Their data were collected, including gender, age, body mass index, COPD duration, onset time, AECOPD ventilation time, complications, APACHE score, GCS score, blood glucose, albumin, hemoglobin, white blood cells, and blood gas analysis. The correlation between the indexes and the treatment effect of noninvasive ventilation were analyzed. Results Univariate analysis showed that the influencing factors of curetive effect included gender, age, BMI, duration of COPD, the onset of AECOPD, noninvasive ventilation time, cardiovascular disease, APACHE Ⅱ score, GCS score, blood glucose, albumin, hemoglobin, white blood cells, procalcitonin, C-reactive protein, serum creatinine, urea nitrogen, PaO2, PaCO2 and p H value (P ＜ 0.05). Multivariate logistic analysis showed that high APACHE Ⅱ score, high procalcitonin intake, and longer ventilation time were independent risk factors for non-invasive ventilation (P ＜ 0.05), and high albumin was a protective factor for successful treatment (P ＜ 0.05). Conclusion Higher APACHE Ⅱ scores, higher engraftment of procalcitonin, longer ventilation time, and higher albumin intake may affect the efficacy of noninvasive ventilation in treatment of AECOPD patients with type Ⅱ respiratory failure. In clinic, comprehensive evaluation and targeted treatment should be based on relevant risk factors to improve the success rate of non-invasive ventilation.%目的 探讨无创通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭的疗效及影响因素.方法 选择2015年1月至2017年8月在我院接受无创通气治疗的237例AECOPDⅡ型呼吸衰竭患者作为研究对象,调阅患者病历,收集患者的性别、年龄、体质量指数、COPD病程、AECOPD发病时间、通气时间、合并疾病、APACHEⅡ评分、GCS评分、血糖、白蛋白、血红蛋白、白细胞、血气分析等资料,分析上述指标与无创通气治疗效果的关系.结果 单因素分析显示,患者性别、年龄、体重指数、COPD病程、AECOPD发病时间、无创通气时间、心血管病、APACHEⅡ评分、GCS评分及入组时血糖、白蛋白、血红蛋白、白细胞、降钙素原、C反应蛋白、肌酐、尿素氮、PaO2、PaCO2、p H值是影响AECOPD合并Ⅱ型呼吸衰竭无创通气治疗效果的因素(P ＜0.05).多因素Logistic分析显示高APACHEⅡ评分、入组时降钙素原高及较长通气时间是无创通气无效的独立危险因素(P ＜0.05),入组白蛋白高是治疗成功的保护性因素(P ＜0.05).结论 高APACHEⅡ评分、入组降钙素原高及较长通气时间及入组白蛋白高等多种因素均可影响无创通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭的疗效,临床中应根据相关危险因素综合评估和针对性治疗,以提高无创通气的成功率.