重症脑梗死患者机械通气后死亡的预测因素分析  

A predictive analysis of the nonsurvivable patients with severe cerebral infarction after mechanical ventilation

作　　者：李淑娟[1] 汪颜[1] 胡文立[1] 

机构地区：[1]首都医科大学附属北京朝阳医院神经内科,北京100020

出　　处：《中国脑血管病杂志》2006年第11期497-500,共4页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨重症脑梗死患者机械通气后死亡的预测因素。方法回顾性分析36例气管插管的急性脑梗死患者的临床资料,根据预后分为死亡组(18例)和存活组(18例)。记录患者气管插管前的格拉斯哥昏迷评分(GCS)、呼吸功能(血气pH值、氧分压、二氧化碳分压和氧合指数)及死亡原因,以60 d为观察终点。结果重症脑梗死患者应用机械通气后60 d的病死率为50%。死亡患者气管插管前GCS评分为3.6±1.0;存活患者为6.3±1.2。两组患者气管插管前表现为氧分压和氧合指数降低。死亡组和存活组氧分压分别为(52±7)和(69±17)mmHg,氧合指数分别为109±34和170±31。单因素分析显示,气管插管前GCS评分降低,氧分压和氧合指数下降是预测死亡的重要因素。多因素回归分析显示,患者气管插管前的GCS评分(P=0.015)及氧分压(P=0.026)为预测机械通气后脑梗死患者60 d死亡的独立因素。结论对重症脑梗死患者,尤其以呼吸系统并发症导致病情恶化者行机械通气支持,有助于降低病死率。综合分析气管插管前患者的意识障碍程度和血液中氧合参数,有助于判断预后。Objective To explore the predictors of the non-survivable patients with severe cerebral infarction after mechanical ventilation. Methods The clinical data of 36 patients with acute cerebral infarction who had tracheal intubation were analyzed retrospectively. The patients were divided into survivor （ n = 18 ） group and non-survivor group （ n = 18 ） according to their prognosis. The observational endpoint was at day 60. Patients＇ Glasgow Coma Scale （GCS） score, respiratory function （ blood gas pH value, oxygen partial pressure, carbon dioxide partial pressure, and oxygenation index） , and the causes of death before tracheal intubation were documented. Results The mortality at day 60 after mechanical ventilation was 50% in patients with severe cerebral infarction. The median GCS score was 3.6 ± 1.0 in the non-survivor group, and the median GCS score was 6. 3 ± 1.2 in the survivor group before tracheal intubation. Oxygen partial pressure and oxygenation index presented to decrease in both groups before the tracheal intubation. The median oxygen partial pressure in the survivor and non-survivor groups were 69 ± 17 and 52 ±7 mm Hg, respectively; and the oxygenation indexes were 170 ±31 and 109 ±34, respectively. The univariate analysis showed that the patients＇ GCS scores decreased before the tracheal intubation. The decrease of oxygen partial pressure and oxygenation index were the important factors for predicting mortalitv. The multivariate regression analysis showed that the patients＇ GCS score （ P = 0. 015 ） and oxygen partial pressure （ P = 0. 026 ） before the tracheal intubation were an independent factors for predicting the mortalitv in patients with cerebral infarction at day 60 after the mechanical ventilation. Conclusion For patients with severe cerebral infarction, the mechanical ventilation support may contribute to decreasing the mortality, particularly in patients whose respiratory system complications have resulted in deterioration of the disease. The aggregate analys

关 键 词：脑梗死 机械通气 病死率 

分 类 号：R743.3[医药卫生—神经病学与精神病学]