本文選題：無創(chuàng)正壓通氣 + 急性呼吸衰竭　； 參考：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討無創(chuàng)正壓通氣(NPPV)對不同病因所致急性呼吸衰竭的療效與安全性。方法采用回顧性分析方法,選擇2010年1月至2015年12月入住北京安貞醫(yī)院呼吸與危重癥醫(yī)學(xué)科重癥監(jiān)護室(RICU)的所有診斷為急性呼吸衰竭,經(jīng)常規(guī)氧療后癥狀無好轉(zhuǎn)或加重并給予NPPV治療的患者,按引起呼吸衰竭的病因分為慢性阻塞性肺疾病組(COPD組)和非COPD組。收集患者的臨床資料,包括性別、年齡、生命體征(呼吸頻率、心率和平均動脈血壓)、動脈血氣分析(pH、PaO2、PaCO2和SaO2)和APACHE II評分,記錄使用NPPV前、1h、2~4h的呼吸頻率、心率、平均動脈血壓和血氣分析測值(pH、PaO2、PaCO2和SaO2),比較各組患者的氣管插管率、病死率和住RICU時間。結(jié)果研究期間,共有252例各種類型的呼吸衰竭患者入住RICU,符合研究納入標(biāo)準(zhǔn)的患者123例(48.8%),男性69例,女性54例,平均年齡(71.0±11.6)歲;COPD組79例,非COPD組44例。COPD組呼吸頻率(21.1±4.5)次/min、心率(88.1±17.4)次/min低于非COPD組(分別為(24.9±7.6)次/min、(95.6±19.5)次/min,P0.05),平均動脈壓[(88±14)mm Hg vs.(88±15)mmHg](1mmHg=0.133KPa)(P0.05)無統(tǒng)計學(xué)差異。COPD組PaCO2(73.4±14.0)mmHg和APACHE II評分(20.9±4.4)顯著高于非COPD組[分別為(65.9±14.0)mmHg和(18.4±4.6)](P均0.05),兩組間pH值(7.302±0.560 vs.7.293±0.477)、PaO2[(60.2±23.6)mm Hg vs.(57.1±15.6)mm Hg]和SaO2[(81.6±14.9)%vs.(82.7±12.6)%]無統(tǒng)計學(xué)差異(P均0.05)。NPPV治療1h、2~4h后兩組的呼吸頻率[1h和2~4h分別為COPD組:(20.5±4.3)次/min和(19.8±3.9)次/min;非COPD組:(21.6±6.2)次/min和(22.0±5.9)次/min]和心率[1h和2~4h分別為COPD組:(86.7±17.4)次/min和(68.7±25.5)次/min;非COPD組:(89.4±15.5)次/min和(71.4±26.9)次/min]減慢(P0.05或P0.01),平均動脈血壓[1h和2~4h分別為COPD組:(85.4±14.2)mmHg、(81.7±11.4)mmHg;非COPD組:(81.6±14.2)mmHg、(80.9±13.2)mm Hg]較基礎(chǔ)值降低(P0.05或P0.01)。動脈血氣分析pH[1h和2~4h分別為COPD組:(7.33±0.06)和(7.36±0.06);非COPD組:(7.34±0.07)和(7.37±0.07)]、PaO2[1h和2~4h分別為COPD組:(75.3±25.1)mmHg和(73.2±21.1)mmHg;非COPD組:(77.4±19.4)mmHg和(82.2±22.7)mmHg]和PaCO2[1h和2~4h分別為COPD組:(69.9±13.5)mmHg和(65.4±10.9)mmHg;非COPD組:(62.6±16.0)mmHg和(60.7±16.7)mm Hg]均較基礎(chǔ)值顯著改善(P0.05或P0.01)。COPD組氣管插管率為5.1%,住院病死率5.1%,均明顯低于非COPD組(分別為15.9%和27.3%)(P0.05或P0.01)。COPD組的成功率為89.9%,顯著高于非COPD組的72.7%(P0.05)。兩組住RICU時間相近(分別為15d vs.16d,P0.05)。結(jié)論NPPV選擇性用于COPD所致急性呼吸衰竭患者,可顯著降低氣管插管率,改善患者的生命體征、血氣分析,療效優(yōu)于非COPD所致急性呼吸衰竭患者。
[Abstract]:Objective to investigate the efficacy and safety of non-invasive positive pressure ventilation (NPPVs) in the treatment of acute respiratory failure (ARF) caused by different causes. Methods all the patients admitted to Beijing Anzhen Hospital from January 2010 to December 2015 were diagnosed as acute respiratory failure by retrospective analysis. The patients who had no improvement or aggravation of symptoms after routine oxygen therapy and were treated with NPPV were divided into two groups according to the etiology of respiratory failure: chronic obstructive pulmonary disease group (COPD group) and non-COPD group. Clinical data were collected, including gender, age, vital signs (respiratory frequency, heart rate and mean arterial blood pressure, arterial blood gas analysis, Pao _ 2 and Sao _ 2) and APACHE II scores. Respiratory frequency and heart rate were recorded 1 hour before NPPV. The mean arterial blood pressure and blood gas were measured at pH of Pao _ 2, Paco _ 2 and Sao _ 2. The tracheal intubation rate, mortality and RICU duration were compared in each group. Results during the study period, 252 patients with various types of respiratory failure were admitted to RICU.123 patients (69 males and 54 females) with COPD of 71.0 鹵11.6 years old were enrolled in the study. 闈濩OPD緇，

本文編號：1799104