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目的评价应用无创正压通气(NPPV)在急性肺损伤(ALI)应用中的相关指征及疗效,初步探讨ALI患者NPPV治疗失败的危险因子。方法采用前瞻性方法分析2007年4月-2010年4月入住ICU诊断ALI并给予NPPV的31例患者,根据治疗结果将患者分为NPPV成功组(15例)和NPPV失败组(16例),比较两组患者的临床资料。结果与失败组相比,成功组的APACHEⅡ、诱因中的肺内感染差异均有统计学意义(P<0.05);应用NPPV的EPAP差异有统计学意义(P<0.01)而IPAP则没有统计学意义;在NIPPV前、NPPV 2 h、NIPPV结束时RR和氧合指数差异均有统计学意义。呼吸频率和氧合指数在组内不同阶段的比较:成功组的RR和PaO2/F iO2在NPPV的过程中有着持续的改善,差异有统计学意义(P<0.01);失败组的氧合指数改善不明显,NPPV后RR较通气前有下降,差异有统计学意义;根据ROC曲线,得出氧合指数(NPPV前)≤139和氧合指数(2 h)≤151可能更易引起NPPV失败,可作为独立的失败因子。结论 NPPV是一种治疗ALI有效安全的方法,在无NPPV禁忌症的情况下,可作为这类患者早期一线呼吸支持的手段,氧合指数(NPPV前)≤139和氧合指数(2 h)≤151可能更易引起NPPV失败。
Objective To evaluate the indications and effects of noninvasive positive pressure ventilation (NPPV) in the treatment of acute lung injury (ALI) and to explore the risk factors of NPPV failure in patients with ALI. Methods A prospective analysis of 31 patients with ICU diagnosed with ALI and NPPV from April 2007 to April 2010 was divided into NPPV success group (n = 15) and NPPV failure group (n = 16) according to the results of treatment. The clinical data of two groups were compared. Results Compared with the failure group, APACHE Ⅱ in the successful group and the inducement of pulmonary infection were significantly different (P <0.05). There was significant difference in EPAP between NPPV group and IPAP group (P <0.01) Significance; before the NIPPV, NPPV2h, NIPPV at the end of RR and oxygenation index differences were statistically significant. Respiratory rate and oxygenation index in different stages of the group comparison: the successful group of RR and PaO2 / F iO2 in NPPV process has continued to improve, the difference was statistically significant (P <0.01); the failure group’s oxygenation index (P <0.05), the NP of RRV was not significantly improved. RR of NPPV was lower than that of ventilation before NPV, and the difference was statistically significant. According to the ROC curve, it was found that oxygenation index (before NPPV) ≤139 and oxygenation index Can be used as an independent failure factor. Conclusions NPPV is an effective and safe method for the treatment of ALI. In the absence of NPPV contraindications, NPPV can be used as a first-line respiratory support for these patients. The oxygenation index (NPPV) ≤139 and oxygenation index (2 h) ≤151 may be more likely to cause NPPV failure.