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目的:分析在急诊应用无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重(AECOPD)失败的因素。方法:45例AECOPD患者给予无创正压通气,通气模式采用压力支持通气(PSV)加呼气末正压通气(PEEP),根据是否需要气管插管分为NPPV成功组和NPPV失败组。比较两组治疗前和治疗后1 h动脉血气、呼吸频率、呼吸困难指数(DS)以及氧合指数(PaO2/FiO2)。结果:治疗1 h后NPPV失败组呼吸频率、DS高于NPPV成功组,而动脉血pH较NPPV成功组低。无创通气失败的独立危险因素有1 h后呼吸频率>20次/min(OR=4.55,95%CI=1.22-16.97),1 h后DS≥5分(OR=9.36,95%CI=2.1-42.8),以及1 h后pH<7.35(OR=10.7,95%CI=1.25-91.6)。结论:急诊NPPV治疗AECOPD后1 h呼吸频率>20次/min、DS≥5分以及pH<7.35则提示NPPV失败的高度可能。
OBJECTIVE: To analyze the factors that have contributed to the failure of emergency treatment of noninvasive positive pressure ventilation (NPPV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: Forty-five patients with AECOPD were treated with noninvasive positive pressure ventilation. Ventilation mode was PSV plus PEEP. According to whether intubation was required or not, the patients were divided into NPPV success group and NPPV failure group. The arterial blood gas, respiratory rate, dyspnea index (DS) and oxygenation index (PaO2 / FiO2) were compared between the two groups before treatment and 1 hour after treatment. Results: After 1 h of treatment, respiratory rate of NPPV failure group was higher than that of NPPV success group, while arterial blood pH was lower than that of NPPV success group. Independent risk factors of noninvasive ventilatory failure after 1 h respiration rate> 20 times / min (OR = 4.55,95% CI = 1.22-16.97), DS ≥ 5 points after 1 h (OR = 9.36,95% CI = 42.8), and pH <7.35 after 1 h (OR = 10.7, 95% CI = 1.25-91.6). Conclusions: Respiratory rate> 20 beats / min 1 hour after emergency NPPV treatment of AECOPD, DS≥5 points and pH <7.35 indicate the high possibility of NPPV failure.