慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭有创机械通气治疗预后因素分析  

Analysis of prognostic factors of invasive mechanical ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with typeⅡrespiratory failure

作　　者：莫琼娅 董年 潘俊杰 楼雅芳[3] MO Qiongya;DONG Nian;PAN Junjie;LOU Yafang(Department of Pulmonary and Critical Care Medicine,Hangzhou Dingqiao Hospital(Hangzhou Hospital of Traditional Chinese Medicine,Dingqiao Branch Hospital),Hangzhou310000,China;Department of Pulmonary and Critical Care Medicine,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou325015,China;Department of Pulmonary and Critical Care Medicine,Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou310007,China)

机构地区：[1]杭州市丁桥医院(杭州市中医院丁桥院区)呼吸与危重症医学科,浙江杭州310000 [2]温州医科大学附属第一医院呼吸与危重症医学科,浙江温州325015 [3]杭州市中医院呼吸与危重症医学科,浙江杭州310007

出　　处：《中国现代医生》2020年第28期105-109,共5页China Modern Doctor

基　　金：浙江省中医药科技计划项目(2020ZQ039)。

摘　　要：目的探讨分析影响慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭行有创机械通气治疗患者的预后因素。方法选择2013年10月~2015年4月收治的慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭有创机械通气治疗患者的临床资料(包括年龄、性别、实验室指标、并发症及合并症等),根据此次住院的临床结局将研究对象分为存活组和死亡组,分析研究对象的各项临床资料,通过单因素和多因素Logistic回归分析,探讨影响其预后的独立因素。结果①入院后两组血红蛋白、血尿素氮、血清清蛋白、有创机械通气后PaCO2下降率是否大于31.64%、并发呼吸机相关性肺炎、并发多脏器功能不全综合征比较,差异有统计学意义(P<0.05)。②有创机械通气后PaCO2下降率是否大于31.64%、并发呼吸机相关性肺炎、并发多脏器功能不全综合征是预后的独立影响因素,PaCO2下降率是其保护因素。结论AECOPD合并Ⅱ型呼吸衰竭行有创机械通气患者并发多脏器功能不全综合征、呼吸机相关性肺炎是预后不良的独立危险因素,而PaCO2下降率>31.64%则是保护因素。Objective To explore and analyze the prognostic factors of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)combined with typeⅡrespiratory failure and who underwent invasive mechanical ventilation.Methods The clinical data(including age,gender,laboratory indicators,complications and comorbidities)of patients with acute exacerbation of chronic obstructive pulmonary disease and invasive mechanical ventilation treatment of typeⅡrespiratory failure admitted from October 2013 to April 2015 were collected.According to the clinical outcome of this hospitalization,the study subjects were divided into survival group and death group.The clinical data of the study subjects were analyzed.Through single factor and multifactor logistic regression analysis,the independent factors affecting their prognosis were explored.Results①There were significant differences in hemoglobin,blood urea nitrogen,serum albumin,whether the decrease rate of PaCO2 after invasive mechanical ventilation was greater than 31.64%,complicated ventilator-associated pneumonia,and complicated multiple organ dysfunction syndrome in both groups after admission(P<0.05).②Whether the decrease rate of PaCO2 after invasive mechanical ventilation was greater than 31.64%,complicated ventilator-associated pneumonia,and multiple organ dysfunction syndrome were independent factors affecting prognosis,and the decrease rate of PaCO2 was its protective factor.Conclusion The complication with multiple organ dysfunction syndrome and ventilator-associated pneumonia in AECOPD combined with typeⅡrespiratory failure patients with invasive mechanical ventilation are independent risk factors for poor prognosis,and the decrease rate of PaCO2 greater than 31.64%is a protective factor.

关 键 词：慢性阻塞性肺疾病急性加重 Ⅱ型呼吸衰竭 有创机械通气 预后因素 

分 类 号：R563[医药卫生—呼吸系统]