慢性阻塞性肺疾病急性加重期患者有创机械通气脱机困难相关危险因素分析  

Risk factors associated with failure of weaning from invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：杨静[1] 赵珂[1] 王大庆[1] 

机构地区：[1]川北医学院附属医院重症医学科,四川南充637000

出　　处：《吉林医学》2018年第1期42-45,共4页Jilin Medical Journal

摘　　要：目的:探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者有创机械通气困难脱机的相关危险因素。方法:采用回顾分析,选取行有创机械通气治疗并符合脱机条件的72例慢性阻塞性肺疾病急性加重期患者。患者进行自主呼吸试验(SBT),观察48 h后无需机械通气患者入选撤机成功组,不能通过SBT或通过SBT 48 h后仍需机械通气治疗者入选撤机失败组。结果:43例入选撤机成功组,29例入选撤机失败组,撤机失败组中脓毒症、多器官功能障碍综合征(MODS)、低蛋白血症、心力衰竭以及糖尿病的发生率均高于撤机成功组。回归分析结果显示,低蛋白症(OR=5.87)、心力衰竭(OR=15.76)、MODS(OR=3.62)、糖尿病(OR=6.05)是撤机失败的危险因素(P<0.05)。结论:低蛋白症、心力衰竭、MODS和糖尿病是撤机失败的危险因素。Objective To investigate the risk factors associated with failure of weaning from invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Method A retrospective study was conducted on 72 patients with AECOPD who received invasive mechanical ventilation and met the weaning criteria. The subjects who passed the spontaneously breathing trial（SBT） and did not need mechanical ventilation within 48 h were enrolled into a weaning success group. The subjects who did not pass the SBT or needed mechanical ventilation again within 48 h were enrolled into a weaning failure group. The risk factors associated with failure of weaning were studied by univariate and multivariate Logistic regression analysis. Results There were 43 subjects in the weaning success group and 29 in the weaning failure group. The incidences of sepsis,multiple organ dysfunction syndrome（MODS）,hypoproteinemia,cardiac failure and diabetes were higher in the weaning failure group than those in the weaning success group. Logistic analysis revealed that hypoproteinemia（OR = 5. 87）,cardiac failure（OR = 15. 76）,MODS（OR = 3. 62）,and diabetes（OR = 6. 05） were risk factors of weaning failure（P 0. 05）.Conclusion Hypoproteinemia,cardiac failure,MODS and diabetes were associated with the failure of weaning from invasive mechanical ventilation in patients with AECOPD.

关 键 词：慢性阻塞性肺疾病 急性加重期 机械通气 脱机 

分 类 号：R563.9[医药卫生—呼吸系统]