无创正压通气对急性百草枯中毒致肺损伤患者氧合状态及预后的影响

Effects of noninvasive positive pressure ventilation on oxygenation status and prognosis in patients with acute paraquat-induced lung injury.

作者信息

Liu Xiao-Wei, Ma Tao, Qu Bo, Liu Zhi

机构信息

Department of Emergency, First Affiliated Hospital, China Medical University, Liaoning, People's Republic of China.

Department of Biostatistics, School of Public Health, China Medical University, Liaoning, People's Republic of China.

出版信息

Clin Ther. 2015 Mar 1;37(3):654-9. doi: 10.1016/j.clinthera.2014.12.016. Epub 2015 Feb 2.

DOI:10.1016/j.clinthera.2014.12.016

PMID:25655533

Abstract

PURPOSE

The aim of this study was to evaluate the effects of noninvasive positive pressure ventilation (NIPPV) on oxygenation status and prognosis in patients with acute lung injury induced by paraquat (PQ) poisoning.

METHODS

Patients with acute PQ-induced lung injury treated with NIPPV were admitted to an emergency intensive care unit. Changes in oxygenation status (respiratory rate and the partial pressure of alveolar O2 and CO2 [PaO2 and PaCO2, respectively]) after initial NIPPV were observed. Differences in inspiratory pressure (PI) between nonsurvivors and survivors were compared. The relationship between PI and the prognosis of patients with acute PQ-induced lung injury was evaluated.

FINDINGS

A total of 86 patients (47 women, 39 men; mean age, 33.5 [24.5] years [range, 22-61 years]) were included. There were significant differences in respiratory rate, PaO2, and PaCO2 from before to after initial NIPPV (respiratory rate, 35 [14] vs 26 [16] min(-1) [P = 0.037]; PaO2, 61.8 [19.6] vs 73.5 [26.8] mm Hg [P = 0.046]; and PaCO2, 27.7 [16.4] vs 34.6 [19.2] mm Hg [P = 0.039]). The overall mortality rate was 75.6% (65/86) during a 28-day follow-up period. We observed a significant difference in initial PI (PIinit) between nonsurvivors and survivors (8.2 [4.3] vs 6.6 [3.8] cm H2O; P = 0.043). Furthermore, nonsurvivors had a greater maximal PI (PImax) than did survivors (21.6 [9.8] vs 15.4 [8.5] cm H2O; P = 0.022). Correlation analysis revealed that both PIinit and PImax were associated with a poor prognosis in patients with acute PQ-induced lung injury (PIinit, r = -0.29 [P = 0.038]; PImax, r = -0.31 [P = 0.042]).

IMPLICATIONS

NIPPV may effectively improve oxygenation status in patients with acute PQ-induced lung injury, thereby relieving dyspnea and promoting the recovery of pulmonary function. PIinit and PImax may be important determinants of prognosis in acute PQ-induced lung injury. These findings need further verification in a large-scale, multicenter, randomized controlled study that combines other factors with a relatively long-term follow-up.

摘要

目的

本研究旨在评估无创正压通气（NIPPV）对百草枯（PQ）中毒所致急性肺损伤患者氧合状态及预后的影响。

方法

接受NIPPV治疗的急性PQ所致肺损伤患者入住急诊重症监护病房。观察初次使用NIPPV后氧合状态（呼吸频率以及肺泡氧分压和二氧化碳分压[分别为PaO₂和PaCO₂]）的变化。比较非存活者与存活者吸气压力（PI）的差异。评估PI与急性PQ所致肺损伤患者预后的关系。

结果

共纳入86例患者（47例女性，39例男性；平均年龄33.5[24.5]岁[范围22 - 61岁]）。初次使用NIPPV前后呼吸频率、PaO₂和PaCO₂存在显著差异（呼吸频率，35[14]次/分钟对26[16]次/分钟[P = 0.037]；PaO₂，61.8[19.6]mmHg对73.5[26.8]mmHg[P = 0.046]；PaCO₂，27.7[16.4]mmHg对34.6[19.2]mmHg[P = 0.039]）。在28天随访期内总死亡率为75.6%（65/86）。我们观察到非存活者与存活者的初始PI（PIinit）存在显著差异（8.2[4.3]cmH₂O对6.6[3.8]cmH₂O；P = 0.043）。此外，非存活者的最大PI（PImax）高于存活者（21.6[9.8]cmH₂O对15.4[8.5]cmH₂O；P = 0.022）。相关性分析显示，PIinit和PImax均与急性PQ所致肺损伤患者的不良预后相关（PIinit，r = -0.29[P = 0.038]；PImax，r = -0.31[P = 0.042]）。