Objective To analyze the risk factors for the failure of noninvasive mechanical ventilation (NIV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD),and to help the clinical risk assessment and decision making.Methods A retrospective case control study was conducted.The patients with AECOPD undergoing NIV admitted to Kaifeng Emergency Center from June 2011 to March 2016 were enrolled,and they were divided into two groups according to whether NIV was successful or not within 12 hours.The nutritional status,blood gas analysis,serum electrolytes,D-dimer,renal function,serum pre-albumin,as well as kinetic vital signs,Glasgow coma scale (GCS) score,expression of respiratory distress,and spontaneous expectoration were recorded.Logistic forward stepwise regression analysis was used to analyze the factors for failure of NIV.Results 122 patients.with the initial NIV were enrolled,with NIV failure in 41 patients within 12 hours,accounted for 33.6％.Compared with NIV success group,the percents of respiratory rate ≥ 25 breaths/min (75.6％ vs.17.3％),expectoration disorders (78.0％ vs.19.8％),circulatory disorders (61.0％ vs.18.5％),malnutrition (61.0％ vs.11.1％),decreased serum pre-albumin (58.5％ vs.17.3％),and GCS score ＜ 12 (75.6％ vs.28.4％) in NIV failure group were significantly increased (all P ＜ 0.05).But there were no significant differences in gender,age,body temperature,blood gas analysis,D-dimer,serum creatinine between two groups.It was shown by the results of binary logistic regression analysis that respiratory rate,expectoration disorders,circulatory disorders,malnutrition,serum pre-albumin,and GCS score were the factors of NIV failure [odds ratio (OR) values were 10.879,6.338,9.860,23.273,8.862,6.774,and P values were 0.011,0.038,0.024,0.003,0.015,0.041,respectively].It was shown by the results of logistic stepwise regression analysis that respiratory rate ≥ 25 breaths/min,expectoration disorders,circulatory disorders,malnutrition,decreased serum pre-albumin,and GCS score ＜ 12 were independent risk factors of NIV failure (OR values were 6.610,5.403,5.138,8.153,4.979,5.100,and P values were 0.007,0.013,0.023,0.007,0.027,0.023,respectively).Conclusions The multiple independent risk factors can induce NIV failure within 12 hours in emergency patients with AECOPD,i.e.increased respiratory rate,expectoration dysfunction,circulatory disorders,malnutrition,decreased serum pre-albumin,and decreased GCS score.Emergency physicians should pay attention to these early risk factors in AECOPD patients,which can be taken as correct judgment and guide.

Objective To analyze the risk factors of failure of emergency treatment with invasive mechanical ventilation (IPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The clinical data of 122 patients with AECOPD to undergo IPPV admitted to the Emergency Center of Kaifeng Central Hospital from July 2015 to March 2018 were retrospectively analyzed. The patient's general information [gender, age, body mass index (BMI)] and the patient's body temperature (T) at initial IPPV, respiratory rate (RR), mean arterial pressure (MAP), heart rate (HR), white blood cell count (WBC), hemoglobin (Hb), electrolyte (K+, Na+ and Cl-), pH value, D-dimer, albumin, C-reactive protein (CRP), blood lactic acid (Lac), B-type brain natriuretic peptide (BNP), procalcitonin (PCT), serum creatinine (SCr), oxygenation index, respiratory index (RI), the occurrence of serious arrhythmia or not, Glasgow coma score (GCS) were statistically analyzed. The indicators with statistical significance in the univariate analysis were introduced into the multivariate Logistic regression analysis to screen out the risk factors affecting the failure of IPPV in the patients; receiver operating characteristic (ROC) curve was drawn to analyze the test effectiveness of the risk factors. Results There were totally 98 cases underwent emergency IPPV, failure in 17 cases and success in 81 cases. The levels of oxygenation index, pH value, WBC and GCS scores of the IPPV success group were significantly higher than those of the IPPV failure group [oxygenation index (mmHg, 1 mmHg =0.133 kPa): 304.10±115.35 vs. 285.93±184.64, pH value: 7.34±0.17 vs. 7.18±0.24, WBC (×109/L): 40.90±8.72 vs. 26.61±6.86, GCS score: 12.42±1.35 vs. 9.89±2.13, all P < 0.05]; the levels of RI, D-dimer, PCT, Lac and incidence of serious arrhythmia in the IPPV success group were significantly lower than those in the IPPV failure group [RI: 2.53±2.39 vs. 3.69±3.64, D-dimer (mg/L): 1.80±0.06 vs. 3.16±2.60, PCT (μg/L): 1.36±0.65 vs. 2.23±2.07, Lac (mmol/L): 3.98±0.63 vs. 7.06±3.44, incidence of serious arrhythmia: 23.46% (19/81) vs. 47.06% (8/17), all P < 0.05]. Logistic regression analysis showed that RI [odds ratio (OR) = 3.479, 95% confidence interval (95%CI)= 1.248-11.996], pH value (OR = 3.153, 95%CI = 1.256-8.656), WBC (OR = 3.364, 95%CI = 1.171-11.561), and the occurrence of severe arrhythmia (OR = 4.125, 95%CI = 0.042-0.342) were risk factors affecting the prognosis of AECOPD patients treated with IPPV (all P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of RI, pH value, WBC and occurrence of severe arrhthmia was 0.718 (P = 0.012), 0.832 (P = 0.008), 0.645 (P = 0.004), 0.617 (P = 0.003), and the sensitivity were 37.0%, 55.6%, 81.5%, 60.4%, the specificity were 19.1%, 26.8%, 60.3%, 83.0% respectively, that had certain value to predict the failure of using IPPV to treat patients with AECOPD. Conclusion Multiple factors may result in failure in emergency patients with AECOPD to apply invasive mechanical ventilator for treatment, that may lead to death, and RI, pH value, WBC, the occurrence of severe arrhythmia are the independent risk factors of failure in such patients using IPPV; emergency physicians should pay attention to AECOPD patients' risk factors at initial period of using IPPV in order to give early warning after assessment.

Objective:To explore the switch time of noninvasive-invasive mechanical ventilation sequential treatment for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and effectively reduce the rate of tracheal intubation.Methods:A retrospective study was performed on patients with AECOPD, who underwent mechanical ventilation in emergency resuscitation room and admitted to department of respiration of Kaifeng Central Hospital Emergency Center from July 2014 to March 2019. The patients who used noninvasive mechanical ventilation (NIV) were included in NIV group (118 cases), and those who used invasive positive pressure ventilation (IPPV) were included in IPPV group (52 cases). The usage of breathing machine time, hospital days and hospital mortality were compared between the two groups. Clinical indicators such as age, gender, body temperature, respiratory rate, body mass index (BMI), mean arterial pressure (MAP), oxygenation index (PaO 2/FiO 2), respiratory index (RI), pH value, D-dimer, hemoglobin (HB), albumin, blood lactate (Lac), brain natriuretic peptide (BNP), C-reactive protein (CRP), procalcitonin (PCT), serum creatinine (SCr), white blood cell count (WBC), Glasgow coma scale (GCS), sputum excretion drainage were collected. The factors influencing the failure of NIV were analyzed by Logistic stepwise regression analysis. The receiver operating characteristic (ROC) curve was used to test the value of the NIV failure risk prediction model. Results:There was no significant difference in total mechanical ventilation time and hospital mortality between NIV group and IPPV group (hours: 65.6±11.11 vs. 66.9±12.1, 6.8% vs. 9.6%, both P > 0.05), but the hospital time in group NIV was significantly shorter than that in IPPV group (days: 12.3±2.1 vs. 14.2±2.5, P < 0.05). In NIV group, 101 cases completed NIV continuously, 17 cases of NIV failure turned to IPPV, and the failure rate of NIV was 14.4%. There were statistically significant differences in gender, PaO 2/FiO 2, RI, pH value, D-dimer, PCT, WBC, Lac, sputum excretion drainage and GCS score between NIV failure patients and NIV success patients. Logistic regression analysis showed that RI, pH value, WBC and sputum excretion drainage were independent risk factors for NIV failure [RI: odds ratio ( OR) = 3.879, 95% confidence interval (95% CI) was 1.258-11.963, P = 0.018; pH value: OR = 3.316, 95% CI was 1.270-8.660, P = 0.014; WBC: OR = 3.684, 95% CI was 1.172-11.581, P = 0.026; sputum excretion drainage: OR = 0.125, 95% CI was 0.042-0.366, P = 0.000]. The NIV failure risk prediction model based on the above independent risk factors had a good goodness of fit ( χ2 = 9.02, P = 0.34). ROC curve analysis showed that the NIV failure risk prediction model had a high predictive value for the patients with AECOPD [the area under ROC curve (AUC) was 0.818±0.051, 95% CI was 0.718-0.918, P = 0.000]. Conclusions:If patients with AECOPD have relative contraindications of NIV but still insist on using NIV, further risk stratification of NIV failure is needed. For those with RI, pH value, WBC abnormalities and sputum excretion drainage, the risk of choosing NIV is significantly increased. We need to pay more attention to the change of the condition and switch to IPPV in time to avoid exacerbation of the condition.

Objective:To investigate the clinical characteristics of pregnant women with leukemia, the condition of leukemia and the influence of clinical treatment on maternal and infant outcomes, and to explore the best clinical management method of leukemia in pregnancy.Methods:Among 79 890 pregnant and lying-in women in Qilu Hospital of Shandong University from January 2004 to December 2015, 22 cases (0.028%) were with leukemia, including 5 cases of leukemia diagnosed before pregnancy [all acute myeloid leukemia (AML)] and 17 cases of leukemia diagnosed for the first time after pregnancy [9 cases of AML, 5 cases of chronic myeloid leukemia (CML), 2 cases of acute lymphoblastic leukemia (ALL), and 1 case of chronic lymphocytic leukemia (CLL)]. According to the gestational weeks of admission and confirmed gestational weeks of leukemia, the 22 patients were divided into early-stage group (initial gestational week < 14 weeks, 5 cases), mid-stage group (newly diagnosed gestational week ≥ 14 weeks and < 28 weeks, 11 cases), and late-stage group (newly diagnosed gestational week ≥ 28 weeks, 6 cases, including 2 cases with previous diagnosis of leukemia). The final pregnancy outcomes included abortion, induced labor, premature delivery, full-term delivery and maternal and infant death. The effects of clinical treatment and obstetric treatment of leukemia on the final maternal and infant outcomes, follow-up to understand the progress of primary disease and fertility of pregnant women, and the impact of leukemia and pregnancy treatment on long-term health status of infants were analyzed.Results:Among 22 patients with leukemia in pregnancy, 14 cases (63.6%) (5 cases in early-stage group and 9 cases in mid-stage group) choosed to give up pregnancy, including 4 cases of early pregnancy abortion and 10 cases of mid pregnancy induced abortion; 12 cases of 14 cases were induced abortion or induced labor after leukemia remission induced by advanced chemotherapy. The remaining 8 patients (2 cases in mid-stage group and 6 cases in late-stage group) continued pregnancy and gave birth to live infants, of which 3 cases received chemotherapy before delivery.Conclusions:Gestational leukemia is a high-risk obstetric case, but it is still expected to achieve good pregnancy outcome under good management and treatment. On the basis of following the principles of leukemia treatment, according to the gestational weeks and patients' wishes, the individualized clinical management plan is formulated, and the accurate chemotherapy timing is conducive to the prognosis of mother and infant.

Objective:To observe the effect of two different screening scales used by 120 dispatchers to early identify stroke patients and give telephone guidance for treatment.Methods:From October 2018 to August 2019, 2 027 stroke and suspect stroke patients who called the Kaifeng 120 Emergency Center were enrolled. The differences in the final positive rate of stroke diagnosis and the incidence of adverse events were compared and analyzed in 1 020 cases using recognition of stroke in the emergency room (ROSIER) and 1 007 cases using facial drooping, arm weakness, speech difficulties and time (FAST) scale scores for telephone guidance.Results:The positive rate of stroke identification in ROSIER score group was higher than that in FAST score group [31.4% (320/1 020) vs. 29.3% (295/1 007)], the false report rate was significantly lower than that in FAST score group [14.9% (152/1 020) vs. 18.8% (189/1 007), P < 0.05], the incidence of adverse events caused by vomiting, falling from bed and convulsions in ROSIER score group were lower than those in FAST score group [0.5% (1/208) vs. 2.2% (4/185), 0% (0/26) vs. 20.0% (2/10), 2.1% (1/48) vs. 10.3% (3/29)], however, the incidence of adverse events caused by falling out of bed was significantly lower ( P < 0.05). The incidence of total adverse events in ROSIER score group was significantly lower than that in FAST score group [0.7% (2/305) vs. 3.8% (9/235), P < 0.05]. The time of FAST score group was shorter than that of ROSIER score group (minutes: 1.2±0.2 vs. 2.5±0.3), but the difference was not statistically significant ( P > 0.05). Conclusions:Two different scales can be used to early identify stroke patients and provide timely pre-hospital guidance, thus reduce the incidence of adverse events. Although the ROSIER score takes longer time, the dispatchers guide the patients by phone which does not affect the dispatch time.