临床误诊误治2012，Vol.25Issue(8)：12-15,4.DOI:10.3969/j.issn.1002-3429.2012.08.004
COPD急性加重并呼吸衰竭患者无创正压通气治疗失败原因分析
Analysis of the Cause of Treatment Failure by Noninvasive Positive Pressure Ventilation in Patients with Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) and Respiratory Failure
摘要
Abstract
Objective To analyze the cause of treatment failure by noninvasive positive pressure ventilation ( NPPV) in patients with exacerbation of chronic obstructive pulmonary disease (COPD) and respiratory failure and explore indication of contraindication and invasive mechanical ventilation. Methods 210 patients with exacerbation of COPD combined with respiratory failure during January 2008 and December 2011 were divided into 2 groups (effective group, non-effective group) according to the results of noninvasive mechanical ventilation. The basic condition, functional disturbance of organ, HPPV influencing factors, complications, the results of blood gas analysis pretherapy and 2-4 hours after NPPN of the two groups were recorded, and the differences of the two groups were compared. The causes of treatment failure of NPPV were analyzed. Results The APACHⅡscore in NPPV non-effective group was significantly higher than that of NPPV effective group ( P < 0.01); albumin levels was lower than that of effective group ( P <0.01). The incidence rates of two organ dysfunctions in NPPV non-effective group (23.0% ) was significantly lower than that of the effective group (51.7% , P<0.01 ) ; but the percentage of more than three organ dysfunctions (76.9% ) was significantly higher than that of the effective group (48.3% , P < 0.01). The incidence rates of renal insufficiency, shock, sputum disorder and vomit aspiration in non-effective group were significantly higher than those of the effective group (P < 0. 01 ). After 2-4 hours of NPPV , the pH and PaCO2 of the effective group were improve significantly than that of the useless group (P <0. 01). Conclusion The high APACH Ⅱ score, the low albumin levels, multiple organ dysfunctions and complications may be the direct cause of treatment failure of NPPV.关键词
肺疾病,慢性阻塞性/呼吸功能不全/连续气道正压通气Key words
Pulmonary disease, chronic obstructive/ Respiratory insufficiency/ Continuous positive airway pressure分类
医药卫生引用本文复制引用
何炜,揭志军,冷蓓峥,鄢莉宏,施劲东,钱凌..COPD急性加重并呼吸衰竭患者无创正压通气治疗失败原因分析[J].临床误诊误治,2012,25(8):12-15,4.基金项目
上海市卫生局科技基金项目(20114307) （20114307）
上海市闵行区卫生局资助项目(2010MW04) （2010MW04）
