困难气道与慢性阻塞性肺疾病急性加重无创机械通气失败的相关性分析(1)
【摘要】目的： 通过对慢性阻塞性肺疾病急性加重(AECOPD)合并II型呼吸衰竭经无创机械通气治疗的患者临床资料的分析，探讨困难气道与无创机械通气失败的相关性。方法： 符合纳入标准及无创机械通气指征的患者103例，分为困难气道组及非困难气道组，在两组患者其他因素差异无显著性的前提下，比较困难气道及非困难气道患者无创机械通气治疗成功率。结果：困难气道患者31例，非困难气道患者72例；治疗成功89例，失败14例，其中困难气道患者9例，非困难气道患者5例，困难气道组失败率高于非困难气道组，差异具有统计学意义(P <0.05)。结论：困难气道是无创机械通气治疗的独立危险因素，会影响治疗效果甚至导致无创机械通气治疗失败率增加。
【关键词】困难气道；慢性阻塞性肺疾病急性加重；II型呼吸衰竭；无创机械通气
[Abstract] Objective： Discuss the correlation between difficult airway and failure of noninvasive mechanical ventilation， according to the analyses of the clinical data of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with hypercapnic respiratory failure treated by noninvasive mechanical ventilation. Method： A total of 103 patients who met the inclusion criteria and the indications of noninvasive mechanical ventilation were selected and were divided into the difficult airway group and the non-difficult airway group. Compare the success rate of non-invasive mechanical ventilation for patients with difficult airway and non-difficult airway based on the prerequisite of no significant difference in other factors between the two groups. Result： There were 31 patients with difficult airway and 72 patients with non-difficult airway. Treatment was successful in 89 cases and was unsuccessful in 14 cases which contain 9 patients with difficult airway and 5 patients with non-difficult airway. The failure rate is higher in the difficult airway group than in the non-difficult airway group. The difference was statistically significant. Conclusion： Difficult airway is an independent risk factor of noninvasive mechanical ventilation treatment， which may affect the treatment effect and even lead to the increase of failure rate of noninvasive mechanical ventilation treatment.
[Key words] Difficult airway；Acute exacerbation of chronic obstructive pulmonary disease；Hypercapnic respiratory failure；Noninvasive mechanical ventilation
【中圖分类号】R197.6 【文献标识码】A 【文章编号】2095-6851(2019)05-023-01
无创机械通气(NPPV)是指在不需要气管插管的情况下，使用无创呼吸机增加自主呼吸患者通气功能的治疗方法[1]。慢性阻塞性肺疾病急性加重期(AECOPD)合并II型呼吸衰竭患者的治疗中，根据病情需要可首选无创机械通气治疗，可降低PaCO2，降低呼吸频率、呼吸困难程度，避免发展至有创机械通气从而减少呼吸机相关肺炎等并发症和住院时间，更重要的是降低病死率和插管率 [2，3]。无创机械通气治疗尚存在一定的失败率，故使用时要参考适应症与禁忌症。我们在临床应用中，观察到存在困难气道的AECOPD患者无创机械通气治疗较非困难气道的AECOPD患者存在相对较高的失败率，分析如下。
1 对象和方法
1.1 对象
1.1.1 纳入标准：收集我院肺病科自2015年1月～2019年1月期间慢性阻塞性肺疾病急性加重(AECOPD)合并II型呼吸衰竭经无创机械通气治疗的患者的临床资料，基础病为慢性阻塞性肺疾病急性加重期，均符合中华医学会呼吸病分会诊断标准[2]，符合II型呼吸衰竭诊断标准。
1.1.2 排除标准：PH7.35；体温>38.0℃；符合有创机械通气指征因拒绝气管插管而行无创机械通气治疗；严重心功能不全；肾功能不全失代偿期。, 百拇医药(许佳 于闯)
【关键词】困难气道；慢性阻塞性肺疾病急性加重；II型呼吸衰竭；无创机械通气
[Abstract] Objective： Discuss the correlation between difficult airway and failure of noninvasive mechanical ventilation， according to the analyses of the clinical data of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with hypercapnic respiratory failure treated by noninvasive mechanical ventilation. Method： A total of 103 patients who met the inclusion criteria and the indications of noninvasive mechanical ventilation were selected and were divided into the difficult airway group and the non-difficult airway group. Compare the success rate of non-invasive mechanical ventilation for patients with difficult airway and non-difficult airway based on the prerequisite of no significant difference in other factors between the two groups. Result： There were 31 patients with difficult airway and 72 patients with non-difficult airway. Treatment was successful in 89 cases and was unsuccessful in 14 cases which contain 9 patients with difficult airway and 5 patients with non-difficult airway. The failure rate is higher in the difficult airway group than in the non-difficult airway group. The difference was statistically significant. Conclusion： Difficult airway is an independent risk factor of noninvasive mechanical ventilation treatment， which may affect the treatment effect and even lead to the increase of failure rate of noninvasive mechanical ventilation treatment.
[Key words] Difficult airway；Acute exacerbation of chronic obstructive pulmonary disease；Hypercapnic respiratory failure；Noninvasive mechanical ventilation
【中圖分类号】R197.6 【文献标识码】A 【文章编号】2095-6851(2019)05-023-01
无创机械通气(NPPV)是指在不需要气管插管的情况下，使用无创呼吸机增加自主呼吸患者通气功能的治疗方法[1]。慢性阻塞性肺疾病急性加重期(AECOPD)合并II型呼吸衰竭患者的治疗中，根据病情需要可首选无创机械通气治疗，可降低PaCO2，降低呼吸频率、呼吸困难程度，避免发展至有创机械通气从而减少呼吸机相关肺炎等并发症和住院时间，更重要的是降低病死率和插管率 [2，3]。无创机械通气治疗尚存在一定的失败率，故使用时要参考适应症与禁忌症。我们在临床应用中，观察到存在困难气道的AECOPD患者无创机械通气治疗较非困难气道的AECOPD患者存在相对较高的失败率，分析如下。
1 对象和方法
1.1 对象
1.1.1 纳入标准：收集我院肺病科自2015年1月～2019年1月期间慢性阻塞性肺疾病急性加重(AECOPD)合并II型呼吸衰竭经无创机械通气治疗的患者的临床资料，基础病为慢性阻塞性肺疾病急性加重期，均符合中华医学会呼吸病分会诊断标准[2]，符合II型呼吸衰竭诊断标准。
1.1.2 排除标准：PH7.35；体温>38.0℃；符合有创机械通气指征因拒绝气管插管而行无创机械通气治疗；严重心功能不全；肾功能不全失代偿期。, 百拇医药(许佳 于闯)