65岁及以上肺炎患者的无创通气失败：咳嗽强度的作用。

Noninvasive ventilation failure in pneumonia patients ≥65years old: The role of cough strength.

作者信息

Hong Yueling, Duan Jun, Bai Linfu, Han Xiaoli, Huang Shicong, Guo Shuliang

机构信息

Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China.

出版信息

J Crit Care. 2018 Apr;44:149-153. doi: 10.1016/j.jcrc.2017.11.008. Epub 2017 Nov 4.

DOI:10.1016/j.jcrc.2017.11.008

PMID:29128779

Abstract

PURPOSE

To explore the association between cough strength and outcomes in elderly patients who received noninvasive ventilation (NIV) due to acute respiratory failure caused by pneumonia.

MATERIALS AND METHODS

We enrolled patients ≥65years old with acute respiratory failure caused by pneumonia. Just before NIV treatment, cough strength was assessed on a cough-strength scale graded from 0 to 5. Patients graded 0-2 were defined as having no/weak coughs and those graded 3-5 were defined as having moderate/strong coughs.

RESULTS

We enrolled 349 patients in this study. The prevalence of no/weak cough was 24% (84/349). Moderate/strong cough patients had lower NIV failure (92/265 [34.7%] vs. 67/84 [79.8%], p<0.01) and lower hospital mortality (85/265 [32.1%] vs. 60/84 [71.4%], p<0.01) than no/weak cough patients. In multivariate logistic regression analysis, we also found that no/weak cough was an independent risk factor for NIV failure (odds ratio=13.83, 95% confidence interval: 6.01-31.81) and death in hospital (odds ratio=4.41, 95% confidence interval: 2.49-7.81).

CONCLUSIONS

In pneumonia patients ≥65years old, no/weak cough is associated with NIV failure and death in hospital. NIV must be used only with caution in no/weak cough patients.

摘要

目的

探讨因肺炎导致急性呼吸衰竭而接受无创通气（NIV）的老年患者咳嗽强度与预后之间的关联。

材料与方法

我们纳入了年龄≥65岁、因肺炎导致急性呼吸衰竭的患者。在进行无创通气治疗前，根据咳嗽强度量表对咳嗽强度进行评估，量表分为0至5级。0至2级的患者被定义为无/弱咳嗽，3至5级的患者被定义为中度/强咳嗽。

结果

本研究共纳入349例患者。无/弱咳嗽的患病率为24%（84/349）。与无/弱咳嗽患者相比，中度/强咳嗽患者的无创通气失败率更低（92/265 [34.7%] 对 67/84 [79.8%]，p<0.01），医院死亡率也更低（85/265 [32.1%] 对 60/84 [71.4%]，p<0.01）。在多因素逻辑回归分析中，我们还发现无/弱咳嗽是无创通气失败（比值比=13.83，95%置信区间：6.01 - 31.81）和住院死亡（比值比=4.41，95%置信区间：2.49 - 7.81）的独立危险因素。