左心功能不全对AECOPD机械通气患者脱机困难影响研究  

Effect of left ventricular dysfunction on weaning patients with mechanical ventilation in AECOPD

作　　者：张宏泽[1] 石斌[1] 唐克强[1] 殷建伟[1] 杨婉花[1] 马国光[2] 

机构地区：[1]南京医科大学附属上海市松江区中心医院急诊危重病科,上海201600 [2]复旦大学附属中山医院重症医学科

出　　处：《临床急诊杂志》2016年第10期756-759,763,共5页Journal of Clinical Emergency

基　　金：上海市松江区第三周期医学领先专业项目(No:2012-III-02)

摘　　要：目的:探讨左心功能不全对慢性阻塞性肺病急性加重(AECOPD)呼吸衰竭机械通气患者脱机困难的影响。方法:选取上海市松江区中心医院重症监护室(ICU)2012-01-2015-02期间55例AECOPD呼吸衰竭有创机械通气患者进行前瞻性队列研究,根据治疗1周后是否脱离呼吸机分为脱机组43例,未脱机组12例,以脉搏指示的连续心输出量监测技术(PiCCO)监测患者治疗前及治疗1周的血流动力学指标:血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI)、心排量指数(CI)、全心舒张末期容积指数(GEDVI)、心功能指数(CFI)、全心射血分数(GEF)、左心室收缩力指数(dP/dtmax)变化,对影响脱机相关因素进行Logistic多因素回归分析。结果:1脱机组治疗后与治疗前相比,EVLWI、GEDVI降低,CI、CFI、GEF、dP/dtmax升高,差异有统计学意义(P<0.05),PVPI在治疗前后差异无统计学意义;2未脱机组治疗后与治疗前相比EVLWI、PVPI、CI、GEDVI、CFI、GEF、dP/dtmax差异无统计学意义;3脱机组治疗后与未脱机组治疗后比较EVLWI、GEDVI更低,CI、CFI、GEF、dP/dtmax更高,差异有统计学意义(P<0.05);4经多因素Logistic回归分析显示治疗后EVLWI、CFI、GEF是AECOPD有创机械通气患者1周脱机困难的独立危险因素。结论:左心功能不全及伴随的肺水肿是影响AECOPD机械通气患者脱机困难的一个重要原因,PICCO技术提供的EVLWI、CFI、GEF治疗后指标可监测此类患者的左心功能状态并预测困难脱机,对AECOPD呼吸衰竭患者机械通气治疗有指导意义。Objective：To investigate the left ventricular dysfunction affects weaning of mechanical ventilation（MV）in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）.Method：We selected 55 AECOPD patients of respiratory failure with mechanical ventilation from January 2012 to February 2015 of GICU in Central Hospital of Songjiang District,and were analyzed with prospective cohort study.According to weaning or not after one week mechanical ventilation treatment is divided into two groups：weaning group of 43 cases and difficulty in withdrawing the mechanical ventilation of 12 cases.Monitoring hemodynamic index such as EVLWI,PVPI,CI,GEDVI,CFI,GEF,dP/dtmax of patients with PiCCO before treatment and after one week.Then take a multivariate regression analysis to study the factors of Mechanical ventilation weaning.Result：The weaning group after treatment compared with before treatment,EVLWI,CI,CFI,GEDVI decreased,GEF,dPmx increased,the difference was statistically significant（P〈0.05）,There was no significant difference of PVPI with treatment.In the difficulty weaning group,showed no significant difference of EVLWI,PVPI,CI,GEDVI,CFI,GEF,dP/dtmax before treated with MV compared to after treatment.After one week treatment,the index of EVLWI and GEDVI were lower,while the index of CI,CFI,GEF and dP/dtmax were higher in weaning group.The difference was statistically significant（P〈0.05）.The results of Logistic regression analysis shows that EVLWI,CFI,GEF are the independent risk factors of difficulty weaning in AECOPD patients with MV after one week.Conclusion：Left ventricular dysfunction and concomitant pulmonary edema is important factors of difficult weaning in respiratory failure of AECOPD patients.These monitoring indicators of EVLWI,CFI and GEF provided by PICCO could evaluate left ventricular function and predict difficulty weaning,and guild the treatment of respiratory failure in AECOPD patients with mechanical ventilation.

关 键 词：慢性阻塞性肺病急性加重 脱机 PICCO 左心功能不全 

分 类 号：R563.1[医药卫生—呼吸系统]