手术后机械通气患者撤机结局的影响因素分析  

Influencing factors of the ventilator weaning outcome in patients undergoing mechanical ventilation after surgery

作　　者：詹亚胜 张骏 Zhan Yasheng;Zhang Jun(Department of Intensive Care Unit,Jinhua People's Hospital,Jinhua,Zhejiang 321021,China;Department of Emergency,Jinhua People's Hospital,Jinhua,Zhejiang 321021,China)

机构地区：[1]金华市人民医院重症医学科,浙江省321021 [2]金华市人民医院急诊科,浙江省321021

出　　处：《中国基层医药》2020年第24期2982-2985,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨手术后需机械通气患者撤机结局的影响因素。方法回顾性分析2017年1月1日至2018年7月31日金华市人民医院手术后需继续机械通气入住重症医学科患者87例的临床资料,根据撤机结局分为成功组(57例)与失败组(30例),收集患者基本临床资料,包括性别、年龄、有无基础疾病、是否为急诊手术,记录患者手术后入住重症医学科24 h内的白蛋白(Alb)、白细胞(WBC)、血红蛋白(HB)、血小板(PLT)、氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数(OI)、乳酸(Lac)、机械通气时间(T),计算入住重症医学科最初24 h内急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分最差值。采用单因素分析和logistic回归分析影响手术后患者撤机结局的危险因素。结果成功组的Scr、APACHEⅡ评分、Lac、PaCO2分别为66.60μmol/L、(21.67±4.67)分、2.60 mmol/L、34.50 mmHg,与失败组的79.00μmol/L、(25.73±4.27)分、5.00 mmol/L、37.80 mmHg相比较,差异均有统计学意义(t=2.224、3.975、2.609、2.001,P=0.026、<0.001、0.009、0.045);单因素分析显示手术后需机械通气患者撤机结局与Scr、APACHEⅡ评分、Lac、PaCO2有关;logistic回归分析显示APACHEⅡ评分B值为0.174,Wald值为6.845,P=0.009,APACHEⅡ评分是手术后患者撤机失败的独立危险因素;绘制APACHEⅡ评分受试者工作特征(ROC)曲线,曲线下面积为0.734,曲线的截断点为22.95,此时对应的灵敏度和特异度分别为59.60%和73.30%。结论APACHEⅡ评分是影响手术后患者撤机结局的独立危险因素,有助于预测手术后机械通气患者的撤机结局,但灵敏度不高。Objective:To investigate the influence factors of ventilator weaning outcome in patients undergoing mechanical ventilation after surgery.Methods:The clinical data of 87 patients undergone postoperative mechanical ventilation and admitted to Intensive Care Unit(ICU)in Jinhua People's Hospital from January 1,2017 to July 31,2018 were retrospectively analyzed.The patients were divided into successful group(57 cases)and failure group(30 cases)according to the weaning outcome.The basic clinical data of the patients were collected,including gender,age,whether they had underlying disease or not and whether it was emergency operation or not.The levels of albumin(ALB),white blood cells(WBC),hemoglobin(HB),platelets(Plt),oxygen partial pressure(PaO2),carbon dioxide partial pressure(PaCO2),oxygenation index(OI),lactate(Lac)and mechanical ventilation time(T)of the patients within 24h of ICU admission after operation were recorded,and the acute physiology and chronic health evaluation scoring systemⅡ(APACHEⅡ)score worst value score of the patients within 24h of ICU admission was calculated.The risk factors affecting the weaning outcome after operation were analyzed using univariate analysis and logistic regression analysis.Results:The creatinine,APACHEⅡ score,Lac,PaCO 2 in the successful group were 66.60mol/L,(21.67±4.67)points,2.60mmol/L,34.50mmHg,respectively,which in the failure group were 79.00mol/L,(25.73±4.27)points,5.00mmol/L,37.80mmHg,respectively,and the differences between the two groups were statistically significant(t=2.224,3.975,2.609,2.001,P=0.026,<0.001,0.009,0.045).The single factor analysis showed that the ventilator weaning outcome in patients undergoing mechanical ventilation after surgery was related with creatinine,APACHEⅡ score,Lac,PaCO2.Logistic regression analysis showed that the APACHEⅡ grade B value was 0.174,Wald value of 6.845,P=0.009<0.05,suggested that APACHEⅡ score was the independent risk factor for surgery patients withdraw machine failure.Draw the APACHEⅡ score ROC curve,the a

关 键 词：围手术期 呼吸 人工 通气机撤除法 氧吸入疗法 重症监护 急性病生理学和长期健康评价 病人结局评价 

分 类 号：R459.7[医药卫生—急诊医学] R619[医药卫生—治疗学]