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目的探讨无创正压通气(NPPV)治疗急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的疗效及影响成败的相关因素。方法 28例ALI/ARDS患者随机分为对照组和NPPV治疗组,所有患者在基础疾病治疗的基础上,对照组采用文丘里面罩吸氧,NPPV治疗组应用NPPV进行呼吸支持。动态观察治疗后的变化,评估达到预设气管插管标准的病例数和相关的指标。结果 NPPV成功率为66.7%(10/15),与对照组比较显著降低气管插管率(33.3%比86.4%,P=0.009),但病死率无显著差异(7.7%比27.3%,P=0.300)。NPPV治疗成功组合并肺部细菌感染和多器官功能损害例数明显少于失败组(2/10比4/5,P=0.01;1/10比3/5,P=0.03)。相关分析显示NPPV治疗失败与合并肺部细菌感染和多器官功能损害显著相关(r=0.58,P<0.05;r=0.53,P<0.05),Logistic逐步回归分析显示合并肺部细菌感染是NPPV失败的独立因素(r2=0.33,P=0.024)。与NPPV治疗前相比,成功组治疗24 h后呼吸频率显著降低[(29±4)次/min比(33±5)次/min,P<0.05],氧合指数(PaO2/FiO2)显著升高[(191±63)mm Hg比(147±55)mm Hg,P<0.05],心率、APACHEⅡ评分、pH值和PaCO2无显著变化(P>0.05);失败组24 h后呼吸频率显著增快[(40±3)次/分min比(33±3)次/min,P<0.05],PaO2/FiO2呈下降趋势[(98±16)mm Hg比(123±34)mmHg,P>0.05]。治疗过程中未观察到NPPV相关的严重不良事件。结论在有选择的病例中,NPPV治疗ALI/ARDS有效和安全,可以改善ALI/ARDS氧合,降低插管率。此研究结果支持NPPV作为ALI/ARDS早期机械通气治疗的一线选择。
Objective To investigate the efficacy of noninvasive positive pressure ventilation (NPPV) in the treatment of acute lung injury / acute respiratory distress syndrome (ALI / ARDS) and its related factors. Methods Twenty-eight patients with ALI / ARDS were randomly divided into control group and NPPV treatment group. All patients were treated with Venturi mask oxygen based on the treatment of basic diseases, and NPPV treatment group received respiratory support. Dynamic changes observed after treatment to assess the number of cases to reach the default tracheal intubation standards and related indicators. Results The success rate of NPPV was 66.7% (10/15). Compared with the control group, the success rate of intubation was significantly lower (33.3% vs. 86.4%, P = 0.009), but the mortality was no significant difference (7.7% vs 27.3%, P = 0.300). The number of cases of successful NPPV combination bacterial infections and multiple organ damage was significantly less in the lung than in the failed group (2/10 vs 4/5, P = 0.01; 1/10 vs 3/5, P = 0.03). Correlation analysis showed that failure of NPPV was significantly associated with pulmonary bacterial infection and multiple organ dysfunction (r = 0.58, P <0.05; r = 0.53, P <0.05). Logistic stepwise regression analysis showed that pulmonary infection was associated with NPPV failure The independent factors (r2 = 0.33, P = 0.024). Compared with those before NPPV treatment, the respiratory rate was significantly decreased in the successful group ([24 ± 4] / min vs (33 ± 5) / min, P <0.05) and PaO2 / FiO2 significantly (191 ± 63) mmHg (147 ± 55) mm Hg, P <0.05], heart rate, APACHEⅡscore, pH and PaCO2 had no significant change (P> 0.05) (40 ± 3) min / min (33 ± 3) min / min, P <0.05, PaO2 / FiO2 showed a decreasing trend (123 ± 34) mmHg > 0.05]. No NPVV-related serious adverse events were observed during the course of treatment. Conclusion In selected cases, NPPV treatment of ALI / ARDS effective and safe, can improve ALI / ARDS oxygenation, reduce the rate of intubation. This finding supports NPPV as a first-line option for early mechanical ventilation in patients with ALI / ARDS.