本文選題：無創(chuàng)正壓通氣 + 膿毒癥　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1評(píng)價(jià)無創(chuàng)正壓通氣(noninvasive positive pressure ventilation,NPPV)用于膿毒癥誘發(fā)的輕中度ARDS的療效及安全性。2分析NPPV治療失敗的獨(dú)立危險(xiǎn)因素,更好的把握NPPV轉(zhuǎn)為IPPV治療的時(shí)機(jī),避免延誤IPPV治療。方法:采用回顧性研究方法,選取2012-2017年保定市第一醫(yī)院重癥醫(yī)學(xué)科收治的嚴(yán)重膿毒血癥合并ARDS的患者共78例,56例患者符合要求納入研究。所有患者,均首先接受NPPV治療,按無創(chuàng)通氣后是否再行有創(chuàng)通氣將患者分為成功組和失敗組。觀察成功組與失敗組入院時(shí)基本情況,包括:性別、年齡、合并癥、APACHEII評(píng)分;應(yīng)用無創(chuàng)通氣的相關(guān)指標(biāo):通氣模式、壓力支持最高水平、最高吸氧濃度、無創(chuàng)通氣總的時(shí)間(小時(shí));觀察兩組無創(chuàng)通氣前及無創(chuàng)通氣2小時(shí)后生命體征(心率、血壓、呼吸頻率)、血?dú)夥治?p H值、Pa CO2、Pa O2)及氧合指數(shù);最后對(duì)兩組的ICU滯留時(shí)間、住院時(shí)間、住院病死率進(jìn)行比較。分析與NPPV治療失敗的相關(guān)獨(dú)立危險(xiǎn)因素。結(jié)果:1 56例患者,成功組36例(64.29%),失敗組20例(35.71%)。2兩組的性別、入院前基礎(chǔ)疾病無顯著差異,與成功組比較,失敗組的平均年齡高、APACHEⅡ評(píng)分高、因肺部感染導(dǎo)致的ARDS比例較高(P均0.01);與成功組比較,NPPV治療2小時(shí)后失敗組的Pa O2/Fi O2改善不明顯(P0.05)。3將單因素分析兩組有差異的指標(biāo)(包括年齡、APACHEⅡ評(píng)分、NPPV前心率、NPPV時(shí)所需Fi O2、NPPV治療2小時(shí)后Pa O2/Fi O2、NPPV治療2小時(shí)后呼吸頻率、因肺部感染導(dǎo)致ARDS)納入多因素分析,通過Logistic回歸分析發(fā)現(xiàn):(1)APACHEⅡ評(píng)分高(OR=3.87,95%CI=1.19-11.76,P=0.039)、(2)NPPV 2小時(shí)后氧合指數(shù)仍145mm Hg(OR=8.21,95%CI=2.46-28.8,P=0.000)、(3)NPPV治療2小時(shí)后呼吸頻率仍30次/分(OR=7.14,95%CI=1.77-21.3,P=0.016)、(4)因肺部感染導(dǎo)致的ARDS的患者(OR=6.13,95%CI=1.80-19.70,P=0.026)是NPPV治療失敗的獨(dú)立危險(xiǎn)因素。4成功組在ICU的平均滯留時(shí)間比失敗組短[5.0天(3.0,8.0)比10.0天(7.0,19.0),P0.01];成功組的病死率明顯低于失敗組(2.8%比35.0%,P0.01)。結(jié)論:1患者APACHEⅡ評(píng)分高、NPPV1小時(shí)后氧合指數(shù)升高不明顯、因肺部感染導(dǎo)致的ARDS是NPPV治療失敗的獨(dú)立危險(xiǎn)因素。2與成功組比較,失敗組在ICU的平均滯留時(shí)間長(zhǎng),失敗組的病死率明顯高于成功組。
[Abstract]:Objective to evaluate the efficacy and safety of noninvasive positive pressure ventilation (NPPV) in sepsis induced mild and moderate positive pressure (ARDS). 2. To analyze the independent risk factors for failure of NPPV treatment, to better grasp the opportunity of NPPV to IPPV therapy and to avoid delay in IPPV treatment. Methods: a retrospective study was conducted on 78 patients with severe sepsis complicated with ARDS admitted from the Department of intensive Medicine of the first Hospital of Baoding City from 2012 to 2017. A total of 56 patients with severe sepsis were included in the study. All patients were treated with NPPV first, and were divided into success group and failure group according to the non-invasive ventilation or non-invasive ventilation. To observe the basic condition of admission in the successful group and the failed group, including gender, age, complication and Apache II score; the related indexes of the application of non-invasive ventilation: ventilation mode, the highest level of pressure support, the highest oxygen concentration. The total time of noninvasive ventilation (hour), vital signs (heart rate, blood pressure, respiratory frequency, blood gas analysis) and oxygenation index were observed before and 2 hours after noninvasive ventilation. Length of stay and mortality were compared. To analyze the independent risk factors associated with the failure of NPPV treatment. Results there was no significant difference in sex between the two groups in 15 6 patients, 36 cases in the success group and 20 cases in the failed group. The average age of the failed group was higher than that of the successful group. The score of Apache 鈪，

本文編號(hào)：1873093