CAJ | 학술논문

目的评价无创正压通气(NPPV)对老年社区获得性肺炎呼吸衰竭的疗效. 方法将321例无心肺复苏、呼吸停止、严重血流动力学不稳定等需紧急气管插管,平均年龄(75.6±12.2)岁伴呼吸衰竭的社区获得性肺炎患者,随机分配给予NPPV(162例)或标准氧疗(159例)作为呼吸衰竭救治方法,比较其插管率、呼吸衰竭控制率及病死率,筛选影响因素. 结果全部患者中,90％为Ⅰ型呼吸衰竭,NPPV组治疗失败插管率低于标准氧疗组(46.9％比64.2％,x2=9.652,P＜0.01),但两组呼吸衰竭控制率无差别(77.9％比72.3％,x2=1.274,P＞0.05),30 d病死率及90 d累积生存率亦无差别.NPPV治疗失败者病死率高于成功者(48.7％比11.6％,x2=26.900,P＜0.01).NPPV治疗失败、简易急性生理评分和年龄高、多肺叶病变是死亡的独立危险因素. 结论 NPPV 可降低老年社区获得性肺炎Ⅰ型呼吸衰竭的插管率,但总体疗效并不突出,应用时需警惕延误插管.
목적 평개무창정압통기(NPPV)대노년사구획득성폐염호흡쇠갈적료효. 방법 장321례무심폐복소、호흡정지、엄중혈류동역학불은정등수긴급기관삽관,평균년령(75.6±12.2)세반호흡쇠갈적사구획득성폐염환자,수궤분배급여NPPV(162례)혹표준양료(159례)작위호흡쇠갈구치방법,비교기삽관솔、호흡쇠갈공제솔급병사솔,사선영향인소. 결과 전부환자중,90％위Ⅰ형호흡쇠갈,NPPV조치료실패삽관솔저우표준양료조(46.9％비64.2％,x2=9.652,P＜0.01),단량조호흡쇠갈공제솔무차별(77.9％비72.3％,x2=1.274,P＞0.05),30 d병사솔급90 d루적생존솔역무차별.NPPV치료실패자병사솔고우성공자(48.7％비11.6％,x2=26.900,P＜0.01).NPPV치료실패、간역급성생리평분화년령고、다폐협병변시사망적독립위험인소. 결론 NPPV 가강저노년사구획득성폐염Ⅰ형호흡쇠갈적삽관솔,단총체료효병불돌출,응용시수경척연오삽관.
Objective To evaluate the efficacy of noninvasive positive-pressure ventilation (NPPV) on acute respiratory failure (ARF) in elderly patients with severe community-acquired pneumonia (CAP).Methods 321 CAP patients with ARF aged over 65 years [(75.6±12.2) years old in averag] were randomly treated with NPPV (n=162) and the standard oxygen therapy (n=159).Intubation rate,ARF control rate and total mortality were compared between the two groups,and the risk factors were analyzed.Results 90％ of 321 patients presented with hypoxemic respiratory failure.Compared with standard therapy group,the intubation rate was lower in NPPV group (46.9％ vs.64.2％,x2=9.652,P＜0.01).However,there were no differences in ARF control rate(77.9％ vs.72.3％,x2 =1.274,P＞0.05),overall 30-day mortality and 90-day survival between the two groups.The overall mortality in NPPV group was higher in treatment failure cases than in treatment success cases (48.7％ vs.11.6％,x2=26.900,P＜0.01).The independent risk factors for death were treatment failure in NPPV,higher simplified acute physiology score assessment,old age and mutilobar infiltrate.Conclusions NPPV can decrease the intubation rate in CAP patients with acute hypoxemic respiratory failure,but the overall efficacy is not significant.Delayed intubation should be avoided when NPPV is to be applicated.