【作者】 王伟；

【导师】 陈兴无；

【作者基本信息】 皖南医学院 ， 临床医学（专业学位）， 2023， 硕士

【摘要】 目的:本研究通过分析无创正压通气（NPPV）治疗慢性阻塞性肺疾病急性发作期（AECOPD）合并Ⅱ型呼吸衰竭患者的基本信息、检查化验指标,探讨NPPV治疗失败相关危险因素,为临床决策提供参考。方法:收集2020年6月至2022年9月皖南医学院第一附属医院使用NPPV治疗AECOPD合并Ⅱ型呼吸衰竭患者107例,根据患者病情转归情况分为治疗成功组84例,治疗失败组23例,比较两组间患者年龄、性别、体重指数（BMI）、体温、心率、呼吸频率、血压、吸烟史、高血压病史、糖尿病病史、格拉斯哥昏迷量表（GCS）评分、急性生理与慢性健康（APACHE）Ⅱ评分、白细胞计数、中性粒细胞百分比、血红蛋白、红细胞分布宽度、超敏C反应蛋白（hs-CRP）、B型利钠肽（BNP）、纤维蛋白原、白蛋白、总胆固醇、甘油三酯、肌酐、胱抑素-C、肌酐/胱抑素-C、双肺平均低密度衰减区百分比（LAA%）、治疗前后酸碱度（PH值）、动脉血氧分压（Pa O₂）、动脉血二氧化碳分压（Pa CO₂）,使用二元logistic回归分析得出导致AECOPD合并Ⅱ型呼吸衰竭使用NPPV治疗失败相关危险因素。结果:1.NPPV治疗成功组及失败组临床基本资料比较:入院时NPPV治疗失败组的APACHEⅡ评分高于成功组（18.52±1.410 vs 13.01±2.051,分）,差异有统计学意义（P<0.001）,而两组患者入院时的年龄、性别、BMI、体温、心率、呼吸、血压、吸烟史、高血压病史、糖尿病病史、GCS评分均无统计学差异（P>0.05）;2.两组间患者入院时血常规、生化及影像学资料对比:入院时失败组患者降钙素原高于成功组（0.052 vs 0.40,ng/m L）,失败组D-二聚体也高于成功组（1.03 vs0.59,ug/m L）,差异有统计学意义（P<0.05）,而两组患者入院时白细胞计数、中性粒细胞百分比、血红蛋白、红细胞分布宽度、hs-CRP、BNP、纤维蛋白原、白蛋白、总胆固醇、甘油三酯、肌酐、胱抑素-C、肌酐/胱抑素-C、双肺平均LAA%无统计学差异（P>0.05）;3.两组患者治疗前后动脉血气对比:入院时两组间患者Pa O₂、Pa CO₂无统计学差异,失败组患者入院时PH值低于成功组（7.23±0.08 vs7.30±0.05）,差异具有统计学意义（P<0.001）,NPPV治疗2小时后两组间患者Pa O₂无统计学差异（P>0.05）,失败组患者治疗后PH值低于成功组（7.25±0.07 vs7.34±0.50）,Pa CO₂高于成功组（82.97±15.78 vs 63.32±13.58,mm Hg）,差异具有统计学意义（P<0.001）;4.对其中具有统计学差异的结果进行多因素logistic回归分析得出APACHEⅡ评分具有统计学差异（P=0.007）,而降钙素原、D-二聚体、入院时PH值、治疗2小时后PH值、治疗2小时后Pa CO₂无统计学差异（P>0.05）。结论:1.患者入院时高APACHEⅡ评分是NPPV治疗AECOPD合并Ⅱ型呼吸衰竭患者失败的可能危险因素。2.AECOPD合并Ⅱ型呼吸衰竭患者的肌酐/胱抑素-C与NPPV治疗失败无明显关系。更多还原

【Abstract】 Objective:In this study,by analyzing the basic information and test indexes of noninvasive positive pressure ventilation（NPPV）in the treatment of patients with acute onset of chronic obstructive pulmonary disease（AECOPD）complicated with respiratory failure type II,the risk factors related to treatment failure of NPPV were explored,providing reference for clinical decision-making.Methods:A total of 107 patients with AECOPD combined with type II respiratory failure treated with NPPV admitted to The First Affiliated Hospital of Wannan Medical College from June 2020 to September 2022 were collected.According to the outcome of the patients,they were divided into a successful treatment group of 84 cases and a failed treatment group of 23 cases.Clinical age,sex,body mass index（BMI）,body temperature,heart rate,respiration,blood pressure,smoking history,hypertension history,diabetes history,Glasgow Coma Scale（GCS）score,acute physiology and chronic health（APACHE）Ⅱscore,white blood cell count,neutrophil percentage,hemoglobin,erythrocyte distribution width and high-sensitivity C-reactive protein（hs-CRP）,Brain natriuretic peptide（BNP）,fibrinogen,albumin,total cholesterol,triglyceride,creatinine,cystatin-C,creatinine/cystatin-C,mean low-density decay area percentage of both lungs（LAA%）,PH before and after treatment,Arterial pressure of oxygen（Pa O₂）,Arterial pressure of carbon dioxide（Pa CO₂）,binary logistic regression analysis was used to determine the risk factors associated with NPPV treatment failure of AECOPD complicated with respiratory failure type II.Results:1.Comparison of basic clinical data between the successful and unsuccessful NPPV treatment groups:The APACHEⅡscore of the failed NPPV treatment group was higher than that of the successful group（18.52±1.410 vs 13.01±2.051,points）.The difference was statistically significant（P<0.001）,but there were no statistically significant differences in age,gender,BMI,body temperature,heart rate,respiration,blood pressure,smoking history,hypertension history,diabetes history and GCS score between the two groups at admission（P>0.05）.2.Comparison of blood routine,biochemical and imaging data on admission between the two groups:On admission,the procalcitonin in the failed group was higher than that in the successful group（0.052 vs0.40,ng/m L）,and the D-dimer in the failed group was also higher than that in the successful group（1.03 vs 0.59,ug/m L）,the difference was statistically significant（P<0.05）.There were no significant differences in white blood cell count,percentage of neutrophils,hemoglobin,distribution width of red blood cells,hs-CRP,BNP,fibrinogen,albumin,total cholesterol,triglyceride,creatinine,cystatin C,creatinine/cystatin C,and average LAA%between the two groups at admission（P>0.05）.3.Comparison of arterial blood gas between the two groups before and after treatment:There was no statistical difference in Pa O₂ and Pa CO₂ between the two groups at admission,the PH value of the failed group was lower than that of the successful group（7.23±0.08 vs7.30±0.05）,the difference was statistically significant（P<0.001）,and there was no statistical difference in Pa O₂ between the two groups after 2 hours of NPPV treatment（P>0.05）.The PH value of the failed group was lower than that of the successful group（7.25±0.07 vs 7.34±0.50）,and the Pa CO₂ was higher than that of the successful group（82.97±15.78 vs 63.32±13.58,mm Hg）,the difference was statistically significant（P<0.001）.4.Multivariate logistic regression analysis of the results with statistical differences showed that there was a statistical difference in APACHEⅡscore（P=0.007）,but no statistical difference in procalcitonin,D-dimer,PH value at admission,PH value 2 hours after treatment and Pa CO₂ 2 hours after treatment（P>0.05）.Conclusion:1.High APACHEⅡscore on admission is a possible risk factor for the failure of NPPV treatment in patients with AECOPD complicated with respiratory failure type II.2.Creatinine/cystatin-C in patients with AECOPD combined with respiratory failure typeⅡhad no predictive value for the therapeutic effect of NPPV.更多还原