Kaya Akın, Ciledağ Aydın, Caylı Ipek, Onen Zeynep Pınar, Sen Elif, Gülbay Banu
Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey.
Tuberk Toraks. 2010;58(2):128-34.
Our aim was to determine associated factors with non-invasive mechanical ventilation (NIMV) failure in acute hypercapnic respiratory failure ninety live patients treated with NIMV for acute hypercapnic respiratory failure were evaluated. While success of NIMV was defined as absence of need of intubation with the patient's discharge from hospital, failure of NIMV was defined as death or need of intubation. The pretreatment pH level was 7.30 in success and 7.28 in failure group (p> 0.05), PaCO(2) was 71.45 mmHg in success and 72.17 mmHg in failure group (p> 0.05). After 1h of NIMV, pH was 7.33 in success and 7.26 in failure group (p= 0.01), PaCO(2) was 65.50 mmHg in success and 73.47 mmHg in failure group (p= 0.02). After 1h of treatment, in success group there was significant increase of pH and decrease of PaCO(2) in contrast to baseline levels, while there was no significant change in failure group. The pretreatment Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II score, serum C-reactive protein level and frequency of associated complication on admission were significantly higher and Glasgow Coma Score was lower in failure group. In conclusion, high APACHE II and C-reactive protein level, low Glasgow Coma Score, associated complication on admission and inadequate response in pH and PaCO(2) after first hour of NIMV are associated factors with NIMV failure.
我们的目的是确定急性高碳酸血症呼吸衰竭患者无创机械通气（NIMV）失败的相关因素。对90例接受NIMV治疗的急性高碳酸血症呼吸衰竭的存活患者进行了评估。NIMV成功定义为患者出院时无需插管，NIMV失败定义为死亡或需要插管。成功组治疗前pH值为7.30，失败组为7.28（p>0.05）；成功组PaCO₂为71.45 mmHg，失败组为72.17 mmHg（p>0.05）。NIMV治疗1小时后，成功组pH值为7.33，失败组为7.26（p=0.01）；成功组PaCO₂为65.50 mmHg，失败组为73.47 mmHg（p=0.02）。治疗1小时后，与基线水平相比，成功组pH值显著升高，PaCO₂降低，而失败组无显著变化。失败组治疗前急性生理与慢性健康状况评估（APACHE）II评分、血清C反应蛋白水平及入院时相关并发症发生率显著更高，格拉斯哥昏迷评分更低。总之，高APACHE II评分、高C反应蛋白水平、低格拉斯哥昏迷评分、入院时相关并发症以及NIMV治疗1小时后pH值和PaCO₂反应不佳是NIMV失败的相关因素。
