2018 年第 10 期 第 13 卷

围术期急性呼吸功能不全患者无创正压通气治疗失败的影响因素分析

Influence factors of noninvasive positive pressure ventilation failure in perioperative patients with acute respiratory insufficiency

作者：拜合提亚尔·克然木米娜瓦尔·热合木

英文作者：

单位：830001乌鲁木齐，新疆维吾尔自治区人民医院重症医学二科（拜合提亚尔·克然木）;830000乌鲁木齐，新疆维吾尔自治区胸科医院呼吸二科（米娜瓦尔·热合木）

英文单位：

关键词：呼吸功能不全；围术期；无创正压通气

英文关键词：

• 摘要：

• 【摘要】目的    探讨围术期急性呼吸功能不全患者无创正压通气（NPPV）治疗失败的影响因素。方法    选取2016年1月至2017年6月在新疆维吾尔自治区人民医院行NPPV治疗的围术期急性呼吸功能不全患者148例，根据患者呼吸功能是否恢复分为成功组（112例）与失败组（36例）。比较2组患者的一般情况、呼吸功能不全原因和分型及并发肺部感染情况；比较治疗期间呼吸机参数，包括通气方式及最高压力支持水平和最高吸入氧浓度；分析2组患者NPPV前及NPPV后1 h动脉血气指标，包括pH值、动脉血二氧化碳分压、氧合指数；应用多因素Logistic回归模型分析NPPV治疗失败的相关危险因素。结果    成功组年龄与急性生理学及慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分均低于失败组［(61±8)岁比（70±7）岁，（11±3）分比（15±4）分］，并发肺部感染率低于失败组［10.7%(12/112)比69.4%（25/36）］，差异均有统计学意义(均P<0.01）；2组呼吸功能不全的原因比较差异有统计学意义(P<0.01)；治疗后成功组最高压力支持水平及最高吸入氧浓度均低于失败组(均P<0.05)；NPPV治疗1 h后2组pH值及氧合指数均高于本组治疗前，且成功组高于失败组（均P<0.05）。Logistic回归分析显示，年龄、APACHE Ⅱ评分、肺部感染为NPPV的危险因素，氧合指数增加为NPPV的保护因素（均P<0.05）。结论    NPPV治疗围术期急性呼吸功能不全患者临床效果肯定，能有效改善患者血气指标。高龄、APACHE Ⅱ评分高、肺部感染是NPPV失败的独立危险因素，氧合指数增加是保护因素。

• 【Abstract】Objective    To investigate the influence factors of noninvasive positive pressure ventilation（NPPV） failure in perioperative patients with acute respiratory insufficiency. Methods    A total of 148 patients sufferring from acute respiratory insufficiency during perioperative period were enrolled from January 2016 to June 2017 in People′s Hospital of Xinjiang Uygur Autonomous Region. All patients were treated with NPPV. According to the therapeutic effect of NPPV and recovery of respiratory function, the patients were divided into success group(n＝112) and failure group(n＝36). General data, cause and type of respiratory insufficiency, occurrence of pulmonary infection were recorded. Respiratory parameters including ventilation mode, maximum pressure support and maximum inspired oxygen fraction were monitored during NPPV. Blood gas indexes including pH value, arterial partial pressure of carbon dioxide and oxygenation index were detected before and 1 h after NPPV. Risk factors of NPPV failure were analyzed by multivariate Logistic regression. Results    Age and score of the Acute Physiology and Chronic Health Evaluation System Ⅱ(APACHE Ⅱ) in success group were significantly lower than those in failure group［(61±8)years vs （70±7）years，（11±3） vs （15±4）］; pulmonary infection rate in success group was significantly lower than that in failure group［10.7%(12/112) vs 69.4%（25/36）］(all P<0.01）. Cause of respiratory insufficiency showed significant difference between groups(P<0.01). After NPPV, maximum pressure support and maximum inspired oxygen fraction in success group were significantly lower than those in failure group(P<0.05). One hour after NPPV, pH value and oxygenation index were significantly higher than those before therapy in both groups; pH value and oxygenation index in success group were significantly higher than those in failure group(P<0.05）. Multivariate Logistic regression analysis showed that age, APACHE Ⅱ score and pulmonary infection were independent risk factors of NPPV failure; oxygenation index was a protective factor（all P<0.05）. Conclusions    NPPV treating perioperative patients with acute respiratory insufficiency can effectively improve respiratory function and blood gas condition. Advanced age, high APACH Ⅱ score and pulmonary infection are independent risk factors of NPPV failure; high oxygenation index is an independent protective factor.