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目的:探讨无创通气失败的早期监测指标。方法:回顾性分析2013-01-2015-01我院收治24h内接受无创通气的40例急性呼吸窘迫综合征(ARDS)患者的临床资料,接受无创通气治疗后24h内无需气管插管为成功组,需气管插管为失败组。记录相关资料并收集接受无创通气前1h内及通气后3h内监测指标,包括心率、体温、呼吸频率、收缩压、舒张压、尿量。结果:7d病死率及28d病死率方面,失败组病死率高于成功组(P<0.01),失败组死亡数为10例(50%)及13例(65%)高于成功组的0例(0)及3例(15%)。在接受无创通气前,失败组的心率及呼吸频率高于成功组;接受无创通气后,失败组的体温、心率及呼吸频率均高于成功组,且心率和呼吸频率前后差值均低于成功组。二项式Logistic回归分析提示体温的暴露风险值最高,另外3项指标数值对预测无创通气失败呈现正相关,而差值呈现负相关。结论:ARDS接受无创通气早期监测应该关注心率、呼吸频率及体温,指标有所回落提示无创通气成功,继续上升则提示无创通气往往无法满足机体,尽早调整为有创通气。
Objective: To investigate the early monitoring indicators of noninvasive ventilation failure. Methods: The clinical data of 40 patients with acute respiratory distress syndrome (ARDS) receiving noninvasive ventilation admitted to our hospital from January 2013 to January 2015 were retrospectively analyzed. No tracheal intubation was required within 24 hours after non-invasive ventilation. , Need intubation for the failure group. Record relevant data and collect monitoring indicators within 1h before non-invasive ventilation and within 3h after ventilation, including heart rate, body temperature, respiratory rate, systolic blood pressure, diastolic blood pressure and urine output. Results: The mortality of 7d and the mortality of 28d were higher in the failure group than in the successful group (P <0.01). The death rate in the failure group was 10 (50%) and 13 (65%) were higher than that in the successful group (0) and 3 cases (15%). Before receiving noninvasive ventilation, the heart rate and respiratory rate of the failed group were higher than those of the successful group. After noninvasive ventilation, the body temperature, heart rate and respiratory rate in the failed group were higher than those in the successful group, and the differences in heart rate and respiratory rate were lower than those in the successful group group. Binomial Logistic regression analysis showed that the highest risk of exposure to body temperature, the other three indicators of the value of non-invasive prediction of non-invasive failure was positively correlated, and the difference was negatively correlated. Conclusion: ARDS should pay attention to heart rate, respiratory rate and body temperature in early monitoring of noninvasive ventilation. The fall of the index suggests that noninvasive ventilation is successful. Continued to rise indicates that noninvasive ventilation often fails to meet the requirements of the body and adjusts to invasive ventilation as soon as possible.