Analysis Of Related Factors Of Non-invasive Positive Pressure Ventilation Failure In Patients With Type Ⅱ Respiratory Failure

Objective:In this study,by analyzing the basic information and test indexes of noninvasive positive pressure ventilation（NPPV）in the treatment of patients with acute onset of chronic obstructive pulmonary disease（AECOPD）complicated with respiratory failure type II,the risk factors related to treatment failure of NPPV were explored,providing reference for clinical decision-making.Methods:A total of 107 patients with AECOPD combined with type II respiratory failure treated with NPPV admitted to The First Affiliated Hospital of Wannan Medical College from June 2020 to September 2022 were collected.According to the outcome of the patients,they were divided into a successful treatment group of 84 cases and a failed treatment group of 23 cases.Clinical age,sex,body mass index（BMI）,body temperature,heart rate,respiration,blood pressure,smoking history,hypertension history,diabetes history,Glasgow Coma Scale（GCS）score,acute physiology and chronic health（APACHE）Ⅱscore,white blood cell count,neutrophil percentage,hemoglobin,erythrocyte distribution width and high-sensitivity C-reactive protein（hs-CRP）,Brain natriuretic peptide（BNP）,fibrinogen,albumin,total cholesterol,triglyceride,creatinine,cystatin-C,creatinine/cystatin-C,mean low-density decay area percentage of both lungs（LAA%）,PH before and after treatment,Arterial pressure of oxygen（Pa O₂）,Arterial pressure of carbon dioxide（Pa CO₂）,binary logistic regression analysis was used to determine the risk factors associated with NPPV treatment failure of AECOPD complicated with respiratory failure type II.Results:1.Comparison of basic clinical data between the successful and unsuccessful NPPV treatment groups:The APACHEⅡscore of the failed NPPV treatment group was higher than that of the successful group（18.52±1.410 vs 13.01±2.051,points）.The difference was statistically significant（P<0.001）,but there were no statistically significant differences in age,gender,BMI,body temperature,heart rate,respiration,blood pressure,smoking history,hypertension history,diabetes history and GCS score between the two groups at admission（P>0.05）.2.Comparison of blood routine,biochemical and imaging data on admission between the two groups:On admission,the procalcitonin in the failed group was higher than that in the successful group（0.052 vs0.40,ng/m L）,and the D-dimer in the failed group was also higher than that in the successful group（1.03 vs 0.59,ug/m L）,the difference was statistically significant（P<0.05）.There were no significant differences in white blood cell count,percentage of neutrophils,hemoglobin,distribution width of red blood cells,hs-CRP,BNP,fibrinogen,albumin,total cholesterol,triglyceride,creatinine,cystatin C,creatinine/cystatin C,and average LAA%between the two groups at admission（P>0.05）.3.Comparison of arterial blood gas between the two groups before and after treatment:There was no statistical difference in Pa O₂ and Pa CO₂ between the two groups at admission,the PH value of the failed group was lower than that of the successful group（7.23±0.08 vs7.30±0.05）,the difference was statistically significant（P<0.001）,and there was no statistical difference in Pa O₂ between the two groups after 2 hours of NPPV treatment（P>0.05）.The PH value of the failed group was lower than that of the successful group（7.25±0.07 vs 7.34±0.50）,and the Pa CO₂ was higher than that of the successful group（82.97±15.78 vs 63.32±13.58,mm Hg）,the difference was statistically significant（P<0.001）.4.Multivariate logistic regression analysis of the results with statistical differences showed that there was a statistical difference in APACHEⅡscore（P=0.007）,but no statistical difference in procalcitonin,D-dimer,PH value at admission,PH value 2 hours after treatment and Pa CO₂ 2 hours after treatment（P>0.05）.Conclusion:1.High APACHEⅡscore on admission is a possible risk factor for the failure of NPPV treatment in patients with AECOPD complicated with respiratory failure type II.2.Creatinine/cystatin-C in patients with AECOPD combined with respiratory failure typeⅡhad no predictive value for the therapeutic effect of NPPV.