pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLCpulmo-3233Research ArticleДОКЛАДЫ МОЛОДЫХ УЧЕНЫХREPORTS OF YOUNG SCIENTISTSФакторы, влияющие на исход неинвазивной вентиляции легких у больных с острой дыхательной недостаточностью на фоне ХОБЛFactors predicting outcome of noninvasive positive pressure ventilation in COPD patientsАвдеевС. Н.AvdeevS. N.

Москва

КуценкоМ. А.KutsenkoM. A.

Москва

ТретьяковА. В.TretyakovA. V.

Москва

ГригорьянцР. А.GrigoryantsR. A.

Москва

ЧучалинА. Г.ChuchalinA. G.

Москва

НИИ пульмонологии М3 РФRussian Federation199830061998023039Copyright © Авдеев С.Н., Куценко М.А., Третьяков А.В., Григорьянц Р.А., Чучалин А.Г., 19981998Авдеев С.Н., Куценко М.А., Третьяков А.В., Григорьянц Р.А., Чучалин А.Г.Avdeev S.N., Kutsenko M.A., Tretyakov A.V., Grigoryants R.A., Chuchalin A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/3233

Успех неинвазивной вентиляции легких (НВЛ) у больных с острой дыхательной недостаточностью (ОДН) на фоне ХОБЛ достигает 70 — 80%. Целью нашего исследования явилось изучение факторов, на основании которых возможен выбор начальной терапии: НВЛ либо интубация трахеи (ИТ) и проведение “традиционной” вентиляции легких. Нами у 38 больных, которым проводилась НВЛ при помощи респиратора BiPAP S/T -D р (Respironics Inc.), ретроспективно были оценены исходные респираторные (газовый анализ артериальной крови, дыхательный паттерн) и нереспираторные показатели (питательный статус, тяжесть состояния, рассчитанная по шкале SAPS), причины ОДН. Терапия НВЛ была успешной у 29 больных (76,3% ) и неуспешной (потребность в ИТ и летальный исход) у 9 больных (23,7% ). Статистически значимые различия между группами были обнаружены в показателях pH: 7,22±0,06 vs 7,28±0,05 (р=0,01), индексе частого поверхностного дыхания RR/Vt: 154±52 vs 107±36 (р=0,004), шкале SAPS: 15,2±2,3 vs 10,8±2,8 баллов (р=0,001), питательном статусе (Body Mass Index - BMI): 18,0±2,7 vs 20,7±2,6 кг/м2 (p < 0,05). В группе “ неуспеха” среди причин ОДН чаще была пневмония (р=0,05). Таким образом, начальный выбор терапии возможен на основании оценки исходных показателей pH, RR/Vt, BMI, SAPS, причины ОДН.

The success rate of noninvasive positive pressure ventilation (NIPPV) in acute exacerbation of chronic obstructive pulmonary disease (COPD) is about 7 0— 80 %. The aim of our study was to determine factors predicting successful outcome of NIPPV.Methods. We analysed 38 patients with acute exacerbation of COPD treated with NIPPV. Noninvasive respiratory support was applied by means of BiPAPS/T-D pventilatory device via nasal or facial masks. All patients were divided in two groups according outcome of NIPPV — need for ET intubation and survival. Pulmonary and nonpulmonary parameters were compared in these groups.Results. NIPPV was successful in 29 patients (76,3% ) and nonsuccessful in 9 patients (23,7% ). Unsuccessfully treated patients were more acidotic on admission (pH: 7,22±0,06. vs 7,2 8± 0,05 ; p = 0,0 1), had greater index of rapid shallow breathing (RR/Vt: 154±52 vs 107±36; p=0 ,0 0 4 ),had more greater length of acute decom pensation before administration o f NIPPV (2,9±1,3 vs 2,1 ±0,7 days; p < 0,05), m ore often had pneumonia as precipitating fa c to r (44,4 vs 6,9% , p=0,05). Outcome was also related to the severity of clinical status assessed by Simplified Acute Physiological Score (SAPS points: 15,2±2,3 vs 10,8±2,8 ; p= 0,001), reduced level of conciousness (1 ,7± 1,3 vs 0,6±0,6 points; p = 0,002), reduced level of com pliance (2,4±1,1 vs 3,7±0,9 points; p= 0,0 01), poor nutritional status (Body M ass Index: 18,0±2,7 vs 20,7±2,6 k g /m 2 ; p < 0,05).Conclusion. Our findings suggest that outcome of NIPPV may be predicted by the level of acidosis, cause of acute respiratory failure, severity of clinical status, level of conciousness, compliance and nutritional status.

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The authors declare that there are no conflicts of interest present.