CAJ | 학술논문

目的探讨免疫抑制(ICH)合并急性呼吸衰竭(ARF)患者接受无创正压通气(NPPV)的疗效及影响NPPV成功的因素。方法选择2008年3月至2011年3月在本院呼吸重症监护病房(RICU)应用NPPV治疗的ICH合并ARF患者，记录其各项临床资料；采用单因素Logistic回归分析NPPV治疗成功的独立影响因素；按临床转归进行免疫状态评估。结果 33例ICH合并ARF患者初始均接受NPPV治疗；其中9例(27.3％)NPPV失败后改用有创机械通气(IMV，失败组)，最终全部死亡；24例(72.7％)仅用NPPV并成功（成功组），最终死亡7例(29.2％)，两组间病死率比较差异有统计学意义(P＜0.01)。除成功组简化急性生理学评分Ⅱ (SAPS Ⅱ，分)显著低于失败组外(33±9比43±5，P＜0.01)，两组其他临床资料比较差异无统计学意义。Logistic回归分析显示，SAPS Ⅱ是NPPV治疗成功的独立影响因素[优势比(OR)=0.83，95％可信区间(95％CI)0.709～0.964，P＜0.05]，且SAPS Ⅱ≥38分是NPPV失败的高危因素[受试者工作特征曲线(ROC)下面积为0.73]。另外，生存组肺损伤评分(LIS，分)显著低于死亡组(1.95±0.48比2.57±0.52，P＜0.01)，CD3+、CD8+T淋巴细胞亚群均高于死亡组(CD3+:0.73±0.16比0.41±0.20;CD8+:0.51±0.18比0.21±0.15，均P＜0.01)。结论 NPPV可用于ICH肺部感染合并ARF的早期治疗，以SAPS Ⅱ ＜38分作为NPPV治疗的选择时机，能有效改善缺氧，避免IMV相关并发症，利于ICH的预后;CD3+、CD8+及LIS评分可以作为评价预后的指标。
목적 탐토면역억제(ICH)합병급성호흡쇠갈(ARF)환자접수무창정압통기(NPPV)적료효급영향NPPV성공적인소。방법 선택2008년3월지2011년3월재본원호흡중증감호병방(RICU)응용NPPV치료적ICH합병ARF환자，기록기각항림상자료；채용단인소Logistic회귀분석NPPV치료성공적독립영향인소；안림상전귀진행면역상태평고。결과 33례ICH합병ARF환자초시균접수NPPV치료；기중9례(27.3％)NPPV실패후개용유창궤계통기(IMV，실패조)，최종전부사망；24례(72.7％)부용NPPV병성공（성공조），최종사망7례(29.2％)，량조간병사솔비교차이유통계학의의(P＜0.01)。제성공조간화급성생이학평분Ⅱ (SAPS Ⅱ，분)현저저우실패조외(33±9비43±5，P＜0.01)，량조기타림상자료비교차이무통계학의의。Logistic회귀분석현시，SAPS Ⅱ시NPPV치료성공적독립영향인소[우세비(OR)=0.83，95％가신구간(95％CI)0.709～0.964，P＜0.05]，차SAPS Ⅱ≥38분시NPPV실패적고위인소[수시자공작특정곡선(ROC)하면적위0.73]。령외，생존조폐손상평분(LIS，분)현저저우사망조(1.95±0.48비2.57±0.52，P＜0.01)，CD3+、CD8+T림파세포아군균고우사망조(CD3+:0.73±0.16비0.41±0.20;CD8+:0.51±0.18비0.21±0.15，균P＜0.01)。결론 NPPV가용우ICH폐부감염합병ARF적조기치료，이SAPS Ⅱ ＜38분작위NPPV치료적선택시궤，능유효개선결양，피면IMV상관병발증，리우ICH적예후;CD3+、CD8+급LIS평분가이작위평개예후적지표。
Objective To evaluate the value of non-invasive positive pressure ventilation (NPPV) in immunocompromised host (ICH) complicated by acute respiratory failure (ARF), and to investigate predictive variables of success with NPPV in ICH with ARF. MethodsA retrospective study of immunocompromised patients with ARF, who were admitted to respiratory intensive care unit (RICU) from March 2008 to March 2011, was performed. Based on clinical data, univariate Logistic regression was done for prediction for independent factors affecting the success of NPPV treatment. Immunization status was assessed according to clinical outcome. Results NPPV was instituted in all 33 cases with ARF initially.Among these patients, 9 patients (27. 3％) received sequential invasive mechanical ventilation (IMV, failure group ) and all of them died finally; among 24 cases (72.7％) who only received NPPV (success group),7 patients died (29. 2％). There was significant difference between the two groups in mortality (P＜0.01).The simplified acute physiology score Ⅱ (SAPS Ⅱ ) in the success group was lower than that in the failure group (33±9 vs. 43±5, P＜0. 01). However, other clinical data showed no statistical significance between two groups. Univariate Logistic regression analysis identified SAPS Ⅱ was the independent factor associated with the success of NPPV treatment [odds ratio (OR) =0.83, 95％ confidence interval (95％ CI) 0. 709-0. 964, P＜0. 05]. And SAPS Ⅱ ≥38 was a risk factor for the failure of NPPV [area under receiver operating characteristic (ROC) curve 0. 73]. In addition, the lung injury scores (LIS) in the survival group was significantly lower than that of the death group (1.95±0.48 vs. 2. 57±0. 52, P＜0.01), the difference was statistically significant. CD3+ and CD8+ T counts in the survivors were higher than that of non-survivors (CD3+∶0.73±0.16 vs. 0.41±0.20; CD8+∶ 0.51±0.18 vs. 0.21±0.15, both P＜0.01), and the difference was statistically significant. Conclusion As an early treatment for ICH with pulmonary infections suffering from ARF, NPPV can be effective for the ICH patients suffering from severe pulmonary infection through improving hypoxemia, ameliorating respiratory distress symptoms, and avoiding complications associated with IMV when SAPS Ⅱ is less than 38. CD3+ , CD8+ , and the LIS can be used to evaluate the prognosis of those patients.