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目的观察重症哮喘患者经无创性鼻(面)罩正压机械通气(NIPPV)治疗后上消化道出血的发生情况,同时分析与上消化道出血有关的因素。方法采用回顾性病例对照研究,选择因重症哮喘住院并采用NIPPV治疗的患者430例。NIPPV后发生上消化道出血者28例为病例组,未发生上消化道出血、与病例组匹配的患者102例为对照组。结果上消化道出血发生率为6.5%(28/430)。病例组病死率为21.4%(6/28),对照组为2.0%(2/102)。在单因素检验中,pH≤7.2(P=0.016)、严重感染(P=0.042)、肺性脑病(P=0.007)是导致上消化道出血的危险因素。将这3项变量导入Logistic回归方程,显示pH≤7.2、存在严重感染是有独立作用的变量。结论NIPPV治疗重症哮喘可降低上消化道出血的发生率,上消化道出血可能提示预后不良,严重酸中毒、严重感染是导致上消化道出血的危险因素。
Objective To observe the incidence of upper gastrointestinal bleeding in patients with severe asthma after non-invasive nasal mask surgery (NIPPV), and to analyze the factors associated with upper gastrointestinal bleeding. Methods A retrospective case-control study was conducted to select 430 patients hospitalized for severe asthma and treated with NIPPV. Twenty-eight cases of upper gastrointestinal bleeding after NIPPV were selected as the case group and no upper gastrointestinal bleeding occurred. Twenty patients matched with the case group were selected as the control group. Results The incidence of upper gastrointestinal bleeding was 6.5% (28/430). The case-fatality rate was 21.4% (6/28) in the control group and 2.0% (2/102) in the control group. In the single-factor test, pH≤7.2 (P = 0.016), severe infection (P = 0.042) and pulmonary encephalopathy (P = 0.007) were the risk factors for upper gastrointestinal bleeding. The three variables were introduced into the Logistic regression equation, showing that pH≤7.2, and the presence of a severe infection was an independent variable. Conclusion NIPPV treatment of severe asthma can reduce the incidence of upper gastrointestinal bleeding, upper gastrointestinal bleeding may prompt poor prognosis, severe acidosis, severe infection is a risk factor for upper gastrointestinal bleeding.