脓毒症诱发的轻中度ARDS患者无创通气失败的多因素分析

发布时间：2018-05-11 07:56

  本文选题：无创正压通气 + 脓毒症　； 参考：《河北医科大学》2017年硕士论文

【摘要】：目的:1评价无创正压通气(noninvasive positive pressure ventilation,NPPV)用于脓毒症诱发的轻中度ARDS的疗效及安全性。2分析NPPV治疗失败的独立危险因素,更好的把握NPPV转为IPPV治疗的时机,避免延误IPPV治疗。方法:采用回顾性研究方法,选取2012-2017年保定市第一医院重症医学科收治的严重脓毒血症合并ARDS的患者共78例,56例患者符合要求纳入研究。所有患者,均首先接受NPPV治疗,按无创通气后是否再行有创通气将患者分为成功组和失败组。观察成功组与失败组入院时基本情况,包括:性别、年龄、合并症、APACHEII评分;应用无创通气的相关指标:通气模式、压力支持最高水平、最高吸氧浓度、无创通气总的时间(小时);观察两组无创通气前及无创通气2小时后生命体征(心率、血压、呼吸频率)、血气分析(p H值、Pa CO2、Pa O2)及氧合指数;最后对两组的ICU滞留时间、住院时间、住院病死率进行比较。分析与NPPV治疗失败的相关独立危险因素。结果:1 56例患者,成功组36例(64.29%),失败组20例(35.71%)。2两组的性别、入院前基础疾病无显著差异,与成功组比较,失败组的平均年龄高、APACHEⅡ评分高、因肺部感染导致的ARDS比例较高(P均0.01);与成功组比较,NPPV治疗2小时后失败组的Pa O2/Fi O2改善不明显(P0.05)。3将单因素分析两组有差异的指标(包括年龄、APACHEⅡ评分、NPPV前心率、NPPV时所需Fi O2、NPPV治疗2小时后Pa O2/Fi O2、NPPV治疗2小时后呼吸频率、因肺部感染导致ARDS)纳入多因素分析,通过Logistic回归分析发现:(1)APACHEⅡ评分高(OR=3.87,95%CI=1.19-11.76,P=0.039)、(2)NPPV 2小时后氧合指数仍145mm Hg(OR=8.21,95%CI=2.46-28.8,P=0.000)、(3)NPPV治疗2小时后呼吸频率仍30次/分(OR=7.14,95%CI=1.77-21.3,P=0.016)、(4)因肺部感染导致的ARDS的患者(OR=6.13,95%CI=1.80-19.70,P=0.026)是NPPV治疗失败的独立危险因素。4成功组在ICU的平均滞留时间比失败组短[5.0天(3.0,8.0)比10.0天(7.0,19.0),P0.01];成功组的病死率明显低于失败组(2.8%比35.0%,P0.01)。结论:1患者APACHEⅡ评分高、NPPV1小时后氧合指数升高不明显、因肺部感染导致的ARDS是NPPV治疗失败的独立危险因素。2与成功组比较,失败组在ICU的平均滞留时间长,失败组的病死率明显高于成功组。
[Abstract]:Objective to evaluate the efficacy and safety of noninvasive positive pressure ventilation (NPPV) in sepsis induced mild and moderate positive pressure (ARDS). 2. To analyze the independent risk factors for failure of NPPV treatment, to better grasp the opportunity of NPPV to IPPV therapy and to avoid delay in IPPV treatment. Methods: a retrospective study was conducted on 78 patients with severe sepsis complicated with ARDS admitted from the Department of intensive Medicine of the first Hospital of Baoding City from 2012 to 2017. A total of 56 patients with severe sepsis were included in the study. All patients were treated with NPPV first, and were divided into success group and failure group according to the non-invasive ventilation or non-invasive ventilation. To observe the basic condition of admission in the successful group and the failed group, including gender, age, complication and Apache II score; the related indexes of the application of non-invasive ventilation: ventilation mode, the highest level of pressure support, the highest oxygen concentration. The total time of noninvasive ventilation (hour), vital signs (heart rate, blood pressure, respiratory frequency, blood gas analysis) and oxygenation index were observed before and 2 hours after noninvasive ventilation. Length of stay and mortality were compared. To analyze the independent risk factors associated with the failure of NPPV treatment. Results there was no significant difference in sex between the two groups in 15 6 patients, 36 cases in the success group and 20 cases in the failed group. The average age of the failed group was higher than that of the successful group. The score of Apache 鈪，

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