无创正压通气治疗不同病因所致急性呼吸衰竭的疗效与安全性研究

发布时间：2018-04-25 01:15

  本文选题：无创正压通气 + 急性呼吸衰竭　； 参考：《首都医科大学》2017年硕士论文

【摘要】：目的探讨无创正压通气(NPPV)对不同病因所致急性呼吸衰竭的疗效与安全性。方法采用回顾性分析方法,选择2010年1月至2015年12月入住北京安贞医院呼吸与危重症医学科重症监护室(RICU)的所有诊断为急性呼吸衰竭,经常规氧疗后症状无好转或加重并给予NPPV治疗的患者,按引起呼吸衰竭的病因分为慢性阻塞性肺疾病组(COPD组)和非COPD组。收集患者的临床资料,包括性别、年龄、生命体征(呼吸频率、心率和平均动脉血压)、动脉血气分析(pH、PaO2、PaCO2和SaO2)和APACHE II评分,记录使用NPPV前、1h、2~4h的呼吸频率、心率、平均动脉血压和血气分析测值(pH、PaO2、PaCO2和SaO2),比较各组患者的气管插管率、病死率和住RICU时间。结果研究期间,共有252例各种类型的呼吸衰竭患者入住RICU,符合研究纳入标准的患者123例(48.8%),男性69例,女性54例,平均年龄(71.0±11.6)岁;COPD组79例,非COPD组44例。COPD组呼吸频率(21.1±4.5)次/min、心率(88.1±17.4)次/min低于非COPD组(分别为(24.9±7.6)次/min、(95.6±19.5)次/min,P0.05),平均动脉压[(88±14)mm Hg vs.(88±15)mmHg](1mmHg=0.133KPa)(P0.05)无统计学差异。COPD组PaCO2(73.4±14.0)mmHg和APACHE II评分(20.9±4.4)显著高于非COPD组[分别为(65.9±14.0)mmHg和(18.4±4.6)](P均0.05),两组间pH值(7.302±0.560 vs.7.293±0.477)、PaO2[(60.2±23.6)mm Hg vs.(57.1±15.6)mm Hg]和SaO2[(81.6±14.9)%vs.(82.7±12.6)%]无统计学差异(P均0.05)。NPPV治疗1h、2~4h后两组的呼吸频率[1h和2~4h分别为COPD组:(20.5±4.3)次/min和(19.8±3.9)次/min;非COPD组:(21.6±6.2)次/min和(22.0±5.9)次/min]和心率[1h和2~4h分别为COPD组:(86.7±17.4)次/min和(68.7±25.5)次/min;非COPD组:(89.4±15.5)次/min和(71.4±26.9)次/min]减慢(P0.05或P0.01),平均动脉血压[1h和2~4h分别为COPD组:(85.4±14.2)mmHg、(81.7±11.4)mmHg;非COPD组:(81.6±14.2)mmHg、(80.9±13.2)mm Hg]较基础值降低(P0.05或P0.01)。动脉血气分析pH[1h和2~4h分别为COPD组:(7.33±0.06)和(7.36±0.06);非COPD组:(7.34±0.07)和(7.37±0.07)]、PaO2[1h和2~4h分别为COPD组:(75.3±25.1)mmHg和(73.2±21.1)mmHg;非COPD组:(77.4±19.4)mmHg和(82.2±22.7)mmHg]和PaCO2[1h和2~4h分别为COPD组:(69.9±13.5)mmHg和(65.4±10.9)mmHg;非COPD组:(62.6±16.0)mmHg和(60.7±16.7)mm Hg]均较基础值显著改善(P0.05或P0.01)。COPD组气管插管率为5.1%,住院病死率5.1%,均明显低于非COPD组(分别为15.9%和27.3%)(P0.05或P0.01)。COPD组的成功率为89.9%,显著高于非COPD组的72.7%(P0.05)。两组住RICU时间相近(分别为15d vs.16d,P0.05)。结论NPPV选择性用于COPD所致急性呼吸衰竭患者,可显著降低气管插管率,改善患者的生命体征、血气分析,疗效优于非COPD所致急性呼吸衰竭患者。
[Abstract]:Objective to investigate the efficacy and safety of non-invasive positive pressure ventilation (NPPVs) in the treatment of acute respiratory failure (ARF) caused by different causes. Methods all the patients admitted to Beijing Anzhen Hospital from January 2010 to December 2015 were diagnosed as acute respiratory failure by retrospective analysis. The patients who had no improvement or aggravation of symptoms after routine oxygen therapy and were treated with NPPV were divided into two groups according to the etiology of respiratory failure: chronic obstructive pulmonary disease group (COPD group) and non-COPD group. Clinical data were collected, including gender, age, vital signs (respiratory frequency, heart rate and mean arterial blood pressure, arterial blood gas analysis, Pao _ 2 and Sao _ 2) and APACHE II scores. Respiratory frequency and heart rate were recorded 1 hour before NPPV. The mean arterial blood pressure and blood gas were measured at pH of Pao _ 2, Paco _ 2 and Sao _ 2. The tracheal intubation rate, mortality and RICU duration were compared in each group. Results during the study period, 252 patients with various types of respiratory failure were admitted to RICU.123 patients (69 males and 54 females) with COPD of 71.0 卤11.6 years old were enrolled in the study. 闈濩OPD缁，

本文编号：1799104