无创正压通气治疗免疫抑制性肺炎所致急性呼吸衰竭的临床评价

发布时间：2018-02-08 19:25

  本文关键词： 无创通气 机械通气 呼吸衰竭 免疫抑制 肺炎　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析无创正压通气(NIPPV)治疗免疫抑制性肺炎的有效率以及失败的预警因素。方法:回顾性分析2012年2月-2017年2月在新疆医科大学第一附属医院呼吸ICU(有25张床位)收治的118例NIPPV治疗免疫抑制性肺炎患者的临床资料。根据患者住院期间是否给予气管插管(ETI)分为未插管组(NIPPV成功组62例)和插管组(NIPPV失败组,56例)。单因素分析两组各项指标,对NIPPV失败的相关因素进一步行Logistic回归分析。绘制受试者工作特征曲线(ROC),评价预警因素对NIPPV治疗失败患者的预测价值。结果:NIPPV治疗免疫抑制性肺炎的成功率为52.5%(62/118例)。与未插管组相比,插管组的体温高[℃:(37.71±0.98)比(37.38±0.76),t=-2.011,P=0.047],pH值[(7.42±0.02)比(7.41±0.03),t=-2.088,P=0.039]亦高,PaCO_2较低[mmHg:(32.28±1.63)比(32.99±1.76),t=2.279,P=0.025]。PaO_2/FiO_2100mmHg的比例[46.4%(26/56)比12.9%(8/62),χ2=16.123,P0.001],APECHEⅡ评分≥20分的比例[91.1%(51/56)比48.4%(30/62),χ2=24.906,P0.001],以及插管组使用血管活性药物的比例[92.9%(52/56)比32.3%(20/62),χ2=45.426,P0.001]均显著增高。插管组和未插管组的病死率有显著性差异[83.9%(47/56)与3.2%(2/62),χ2=78.921,P0.001]。而基础疾病、肺炎原发/继发的比例在插管组和未插管组的分布显示无统计学意义(均P0.05)。多因素Logistic回归分析显示APACHEⅡ评分≥20分[95%可信区[95%可信区(95%CI)=0.014-0.408,P=0.006]、PaO_2/FiO_2100mmHg[95%CI=2.175-107.252,P=0.003],以及使用血管活性药物[95%CI=6.974-183.124,P0.001]是NIPPV失败的危险因素。预测NIPPV失败的ROC曲线下面积(AUC)分析显示APACHEⅡ评分≥20分的AUC为0.787,高于PaO_2/FiO_2100mmHg(AUC为0.757),其灵敏度为83.93%,特异度为69.35%,阳性预测值为71.21%,阴性预测值为82.69%,阳性似然比为2.74,阴性似然比为0.23,约登指数为0.53。结论:52.5%免疫抑制患者在行NIPPV治疗过程中不需要ETI,而且是否ETI不依赖于急性呼吸衰竭的病因。入院时APACHEⅡ评分≥20分、PaO_2/FiO_2100mm Hg以及血管活性药物需求是NIPPV失败的预警因素。
[Abstract]:Objective: to analyze the effective rate and early warning factors of failure in the treatment of immunosuppressive pneumonia with noninvasive positive pressure ventilation (NIPPVV). Methods: the respiratory ICU (25 cases) in the first affiliated Hospital of Xinjiang Medical University from February 2012 to February 2017 were analyzed retrospectively. The clinical data of 118 patients with immunosuppressive pneumonia treated with NIPPV were divided into two groups according to whether endotracheal intubation was given to 62 patients without intubation and 56 patients from failed intubation group. Analysis of the two sets of indicators, Further Logistic regression analysis was performed on the related factors of NIPPV failure. The operating characteristic curve was drawn to evaluate the predictive value of early warning factors in patients with failed NIPPV treatment. Results the success rate of NIPPV in treating immunosuppressive pneumonia was 52.5% 62 / 118 cases. Compared with the non-intubation group, The body temperature in the intubation group was higher than that in the control group [7.42 卤0.02) and 7.41 卤0.038 卤0.038 卤0.76, respectively, and the ratio of Paco _ 2 score 鈮，

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