慢性阻塞性肺疾病急性加重期无创正压通气患者的半定量咳嗽强度评分及相关结局

Semiquantitative cough strength score and associated outcomes in noninvasive positive pressure ventilation patients with acute exacerbation of chronic obstructive pulmonary disease.

作者信息

Fan Liping, Zhao Qinghua, Liu Yucun, Zhou Lintong, Duan Jun

出版信息

Respir Med. 2014 Dec;108(12):1801-7. doi: 10.1016/j.rmed.2014.10.001.

DOI:10.1016/j.rmed.2014.10.001

PMID:25459451

Abstract

BACKGROUND

Weak cough may result in the failure of noninvasive positive pressure ventilation (NPPV) in patients with AECOPD. However, no detailed descriptions have yet been published for the measurement of cough strength and associated outcomes in AECOPD patients.

METHODS

This study prospectively enrolled 261 AECOPD patients who received NPPV. Semiquantitative cough strength score (SCSS, ranging from 0 = weak to 5 = strong) was recorded before NPPV. Patients who required intubation were defined as NPPV failures.

RESULTS

NPPV failed in 55 patients (21.1%). Weak cough (SCSS ≤3, OR = 8.1), high disease severity (APACHE II score >19, OR = 3.8), and malnutrition (total proteins ≤58 g/L, OR = 2.8) were independent risk factors for NPPV failure. Patients with 1, 2, and 3 risk factors were 4.7, 13.6, and 21.6 times more likely, respectively, to experience NPPV failure compared with patients with no risk factors. The NPPV failure rates were 80%, 40%, and 10.2% in patients with SCSS of 0–1, 2–3, and 4–5, respectively (p < 0.001). Compared with NPPV success patients, NPPV failure patients stayed longer in ICU (10.1 ± 7.9 days vs. 6.5 ± 4.6 days, p < 0.001), and they had higher ICU costs (€2986 ± 1906 vs. €5680 ± 3,604, p < 0.001), higher hospital costs (€ 6714 ± 7025 vs. €10,399 ± 9,509, p = 0.009), and higher hospital mortality (72.7% vs. 4.4%, p < 0.001). Moderate accuracy to distinguish NPPV failure by APACHE II score, SCSS, and total proteins was evidenced by ROC curves, with areas under the curve of 0.71, 0.78, and 0.67, respectively. A combination of all three factors reached good accuracy, with an area under the curve of 0.86.

CONCLUSION

AECOPD patients with weak cough had a high risk of NPPV failure. SCSS, APACHE II scores, and total proteins were predictors of NPPV failure. Combined, these factors increased the power to predict NPPV failure.

摘要

背景

咳嗽无力可能导致慢性阻塞性肺疾病急性加重期（AECOPD）患者无创正压通气（NPPV）失败。然而，目前尚无关于AECOPD患者咳嗽强度测量及相关结果的详细描述。

方法

本研究前瞻性纳入了261例接受NPPV的AECOPD患者。在进行NPPV之前记录半定量咳嗽强度评分（SCSS，范围从0=弱到5=强）。需要插管的患者被定义为NPPV失败。

结果

55例患者（21.1%）NPPV失败。咳嗽无力（SCSS≤3，OR=8.1）、疾病严重程度高（急性生理与慢性健康状况评分系统II（APACHE II）评分>19，OR=3.8）和营养不良（总蛋白≤58 g/L，OR=2.8）是NPPV失败的独立危险因素。与无危险因素的患者相比，有1、2和3个危险因素的患者发生NPPV失败的可能性分别高4.7、13.6和21.6倍。SCSS为0-1、2-3和4-5的患者NPPV失败率分别为80%、40%和10.2%（p<0.001）。与NPPV成功的患者相比，NPPV失败的患者在重症监护病房（ICU）停留时间更长（10.1±7.9天对6.5±4.6天，p<0.001），ICU费用更高（2986±1906欧元对5680±3604欧元，p<0.001），住院费用更高（6714±7025欧元对10399±9509欧元，p=0.009），医院死亡率更高（72.7%对4.4%，p<0.001）。APACHE II评分、SCSS和总蛋白区分NPPV失败的准确性中等，ROC曲线显示曲线下面积分别为0.71、0.78和0.67。所有三个因素联合使用达到了良好的准确性，曲线下面积为0.86。