标题：有创-无创序贯机械通气治疗AECOPD合并呼吸衰竭失败的相关因素分析

      作者：魏娜 1，周斌 2，傅兴隆 2    西安市北方医院呼吸内科 1、急诊科 2，陕西 西安 710043

      卷次： 2021年32卷4期

      【摘要】 目的 探讨有创-无创序贯机械通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭失败的相关影响因素。方法 回顾性分析2016年8月至2018年8月西安市北方医院收治的128例AECOPD合并呼吸衰竭患者的临床资料，所有患者均给予有创-无创序贯机械通气治疗，按治疗效果将其分为有效组93例和无效组35例，比较两组患者的年龄、性别、病程、心率(HR)、血压、低蛋白血症、氧分压(PaO2)、二氧化碳分压(PaCO2)、通气时间、APACHEⅡ评分、并发症情况、C反应蛋白(CRP)水平、血乳酸浓度等一般资料，采用Logistic多因素回归分析法分析治疗失败的相关影响因素。结果 两组患者在性别、病程、HR、血压、低蛋白血症、PaO2、通气时间、并发症情况方面比较差异均无统计学意义(P>0.05)；无效组和有效组患者在年龄[(68.88±4.43)岁 vs (59.02±4.57)岁]、PaCO2[(83.65 ± 10.12) mmHg vs (73.79 ± 10.54) mmHg]、APACHEⅡ评分 [(19.16 ± 6.68)分 vs (11.34 ± 3.85)分]、CRP水平[(89.65±10.31) mg/L vs (80.23±10.21) mg/L]、血乳酸浓度[(2.98±0.60) mmol/L vs (1.93±0.68) mmol/L]方面比较，无效组明显高于有效组，差异均有统计学意义(P<0.05)；经Logistic多因素回归分析结果显示，PaCO2、APACHEⅡ评分、CRP水平、血乳酸浓度是有创-无创序贯机械通气治疗AECOPD合并呼吸衰竭失败的独立影响因素(OR=2.280、2.307、1.042、1.413，P<0.05)。结论 PaCO2≥75 mmHg、APACHEⅡ评分>15分、CRP≥85 mg/L、血乳酸浓度>1.7 mmol/L是有创-无创序贯机械通气治疗AECOPD合并呼吸衰竭失败的独立危险因素；在制定临床诊疗方案前应考虑上述指标影响，以最大程度地避免治疗失败。
      【关键词】 创-无创序贯机械通气；慢性阻塞性肺疾病；急性加重期；呼吸衰竭；独立危险因素
      【中图分类号】 R563 【文献标识码】 A 【文章编号】 1003—6350（2021）04—0446—04

Analysis on the related factors of unsuccessful invasive-noninvasive sequential mechanical ventilation forAECOPD combined with respiratory failure.
WEI Na 1, ZHOU Bin 2, FU Xing-long 2. Department of RespiratoryMedicine 1, Emergency Department 2, Xi'an North Hospital, Xi'an 710043, Shaanxi, CHINA
【Abstract】 Objective To explore the influencing factors of unsuccessful invasive-noninvasive sequential me-chanical ventilation for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with respira-tory failure. Methods The clinical data of 128 patients with AECOPD and respiratory failure who were admitted toXi'an North Hospital from August 2016 to August 2018 were retrospectively analyzed. All the patients were treated withinvasive-noninvasive sequential mechanical ventilation. According to different curative effect, they were divided into ef-fective group (n=93) and ineffective group (n=35). The general data, including age, gender, course of disease, heart rate(HR), blood pressure, hypoproteinemia, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2),ventilation time, APACHEⅡ score, complications, level of C-reactive protein (CRP), concentration of blood lactic acid(BLA) were compared between the two groups. The related influencing factors of treatment failure were analyzed by lo-gistic multivariate regression analysis. Results There were no significant differences between the two groups ingender, disease course, HR, blood pressure, hypoproteinemia, PaO2, ventilation time, and complications (P>0.05).The ineffective group were significantly higher than the effective group in the following indexes (P<0.05): age,(68.88±4.43) years old vs (59.02±4.57) years old; PaCO2, (83.65±10.12) mmHg vs (73.79±10.54) mmHg; APACHEⅡscore, (19.16±6.68) points vs (11.34±3.85) points; CRP level, (89.65±10.31) mg/L vs (80.23±10.21) mg/L; and BLA con-centration, (2.98±0.60) mmol/L vs (1.93±0.68) mmol/L. Multivariate Logistic regression analysis showed that PaCO2,APACHEⅡ score, CRP level, and BLA concentration were independent influencing factors of unsuccessful inva-sive-noninvasive sequential mechanical ventilation for AECOPD combined with respiratory failure (OR=2.280, 2.307,1.042, 1.413, P<0.05). Conclusion PaCO2≥75 mmHg, APACHEⅡ score>15 points, CRP≥85 mg/L, and BLA concen-tration>1.7 mmol/L are independent risk factors of invasive-noninvasive sequential mechanical ventilation in the failuretreatment of AECOPD and respiratory failure. The effects of the above indexes should be considered before developingclinical diagnosis and treatment plans to avoid treatment failure to the greatest extent.
      【Key words】 Invasive-noninvasive sequential mechanical ventilation; Chronic obstructive pulmonary disease;Acute exacerbation period; Respiratory failure; Independent risk factor