本文關(guān)鍵詞： 無創(chuàng)通氣 機(jī)械通氣 呼吸衰竭 免疫抑制 肺炎　出處：《新疆醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析無創(chuàng)正壓通氣(NIPPV)治療免疫抑制性肺炎的有效率以及失敗的預(yù)警因素。方法:回顧性分析2012年2月-2017年2月在新疆醫(yī)科大學(xué)第一附屬醫(yī)院呼吸ICU(有25張床位)收治的118例NIPPV治療免疫抑制性肺炎患者的臨床資料。根據(jù)患者住院期間是否給予氣管插管(ETI)分為未插管組(NIPPV成功組62例)和插管組(NIPPV失敗組,56例)。單因素分析兩組各項(xiàng)指標(biāo),對NIPPV失敗的相關(guān)因素進(jìn)一步行Logistic回歸分析。繪制受試者工作特征曲線(ROC),評價預(yù)警因素對NIPPV治療失敗患者的預(yù)測價值。結(jié)果:NIPPV治療免疫抑制性肺炎的成功率為52.5%(62/118例)。與未插管組相比,插管組的體溫高[℃:(37.71±0.98)比(37.38±0.76),t=-2.011,P=0.047],pH值[(7.42±0.02)比(7.41±0.03),t=-2.088,P=0.039]亦高,PaCO_2較低[mmHg:(32.28±1.63)比(32.99±1.76),t=2.279,P=0.025]。PaO_2/FiO_2100mmHg的比例[46.4%(26/56)比12.9%(8/62),χ2=16.123,P0.001],APECHEⅡ評分≥20分的比例[91.1%(51/56)比48.4%(30/62),χ2=24.906,P0.001],以及插管組使用血管活性藥物的比例[92.9%(52/56)比32.3%(20/62),χ2=45.426,P0.001]均顯著增高。插管組和未插管組的病死率有顯著性差異[83.9%(47/56)與3.2%(2/62),χ2=78.921,P0.001]。而基礎(chǔ)疾病、肺炎原發(fā)/繼發(fā)的比例在插管組和未插管組的分布顯示無統(tǒng)計學(xué)意義(均P0.05)。多因素Logistic回歸分析顯示APACHEⅡ評分≥20分[95%可信區(qū)[95%可信區(qū)(95%CI)=0.014-0.408,P=0.006]、PaO_2/FiO_2100mmHg[95%CI=2.175-107.252,P=0.003],以及使用血管活性藥物[95%CI=6.974-183.124,P0.001]是NIPPV失敗的危險因素。預(yù)測NIPPV失敗的ROC曲線下面積(AUC)分析顯示APACHEⅡ評分≥20分的AUC為0.787,高于PaO_2/FiO_2100mmHg(AUC為0.757),其靈敏度為83.93%,特異度為69.35%,陽性預(yù)測值為71.21%,陰性預(yù)測值為82.69%,陽性似然比為2.74,陰性似然比為0.23,約登指數(shù)為0.53。結(jié)論:52.5%免疫抑制患者在行NIPPV治療過程中不需要ETI,而且是否ETI不依賴于急性呼吸衰竭的病因。入院時APACHEⅡ評分≥20分、PaO_2/FiO_2100mm Hg以及血管活性藥物需求是NIPPV失敗的預(yù)警因素。
[Abstract]:Objective: to analyze the effective rate and early warning factors of failure in the treatment of immunosuppressive pneumonia with noninvasive positive pressure ventilation (NIPPVV). Methods: the respiratory ICU (25 cases) in the first affiliated Hospital of Xinjiang Medical University from February 2012 to February 2017 were analyzed retrospectively. The clinical data of 118 patients with immunosuppressive pneumonia treated with NIPPV were divided into two groups according to whether endotracheal intubation was given to 62 patients without intubation and 56 patients from failed intubation group. Analysis of the two sets of indicators, Further Logistic regression analysis was performed on the related factors of NIPPV failure. The operating characteristic curve was drawn to evaluate the predictive value of early warning factors in patients with failed NIPPV treatment. Results the success rate of NIPPV in treating immunosuppressive pneumonia was 52.5% 62 / 118 cases. Compared with the non-intubation group, The body temperature in the intubation group was higher than that in the control group [7.42 鹵0.02) and 7.41 鹵0.038 鹵0.038 鹵0.76, respectively, and the ratio of Paco _ 2 score 鈮，

本文編號：1496083