有创机械通气对原发性脑出血合并呼吸衰竭患者血气指标影响及撤机拔管影响因素分析  

Effect of invasive mechanical ventilation on blood gas indexes in patients with primary intracerebral hemorrhage complicated with respiratory failure and analysis on influencing factors for extubation

作　　者：黄斌 陈佳楠 王超国 丁海龙 HUANG Bin;CHEN Jianan;WANG Chaoguo;DING Hailong(Department of Neurosurgery,Xinchang Hospital of Traditional Chinese Medicine,Xinchang 312500,China;不详)

机构地区：[1]新昌县中医院神经外科,312500 [2]新昌县中医院重症监护室,312500

出　　处：《心电与循环》2025年第1期71-76,共6页Journal of Electrocardiology and Circulation

摘　　要：目的探讨有创机械通气(IMV)对原发性脑出血(ICH)合并呼吸衰竭患者血气指标影响及撤机拔管影响因素。方法回顾性选取2018年5月至2023年5月在新昌县中医院接受IMV治疗的原发性ICH合并呼吸衰竭患者80例,根据治疗后3 d存活情况分为存活组60例和死亡组20例;存活患者根据撤机拔管结局分为成功组46例和失败组14例。比较存活组与死亡组、成功组与失败组临床资料,采用ROC曲线分析血气指标变化绝对值对治疗后3 d存活情况的预测效能,采用多因素logistic回归分析患者撤机拔管结局的影响因素。结果死亡组患者年龄、出血量均高于存活组(均P<0.05),动脉血氧分压(PaO_(2))和格拉斯哥昏迷评分治疗前、治疗后24 h、变化绝对值以及动脉血二氧化碳分压(PaCO_(2))、平均动脉压(MAP)、美国国立卫生研究院卒中量表(NIHSS)评分、急性生理学和慢性健康状况评价(APACHE)Ⅱ评分变化绝对值均明显低于存活组(均P<0.05),PaCO_(2)、MAP、NIHSS评分和APACHEⅡ评分治疗前、治疗后24 h均明显高于存活组(均P<0.05)。PaO_(2)、PaCO_(2)和MAP变化绝对值预测治疗后3 d存活的AUC分别为0.890、0.858和0.818。失败组患者年龄、出血量和治疗后24 h NIHSS评分、APACHEⅡ评分均明显高于成功组(均P<0.05)。年龄(OR=2.330)、出血量(OR=2.807)和治疗后24 h NIHSS评分(OR=4.225)、APACHEⅡ评分(OR=3.873)均是患者撤机拔管结局的独立影响因素(均P<0.01)。结论IMV能改善原发性ICH合并呼吸衰竭患者血气指标和神经功能,撤机拔管受患者年龄、出血量、NIHSS评分和APACHEⅡ评分的影响。Objective To explore effect of invasive mechanical ventilation(IMV)on blood gas indexes in patients with primary intracerebral hemorrhage(ICH)complicated with respiratory failure and analysis on influencing factors for extubation.Methods Eighty patients with primary ICH complicated with respiratory failure who received IMV in Xinchang Hospital of Traditional Chinese Medicine from May 2018 to May 2023 were selected.Based on the survival rate after three days of treatment,the patients were divided into a survival group(n=60)and a death group(n=20).At the same time,among survival patients,they were divided into two groups based on the status of extubation:the successful extubation group(n=46)and the failed extubation group(n=14).The clinical data,including mean arterial pressure(MAP),arterial oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2)),National Institute of Health Stroke Scale(NIHSS),Acute Physiological and Chronic Health Score(APACHE)Ⅱ,and Glasgow Coma Score,between survival and death groups,and between successful extubation and failed extubation groups were compared.ROC curve was used to analyze the predictive efficacy of absolute changes in blood gas indexes on 3-day survival after treatment.Mutivariate logistic regression analysis was used to analyze influencing factors for outcomes of extubation.Results The age and bleeding volume of patients in the death group were significantly higher than those of the survival group(both P<0.05).PaO_(2) and Glasgow Coma Score before and 24 hours after treatment and absolute changes,and the absolute changes of PaCO_(2),MAP,NIHSS Score,and APACHEⅡScore in the death group were significantly lower than those of the survival group(all P<0.05).PaCO_(2),MAP,NIHSS Score and APACHEⅡScore before and 24 hours after treatment in the death group were significantly higher than those of the survival group(all P<0.05).The AUCs of absolute value changes of PaO_(2),PaCO_(2),and MAP in predicting 3-day survival were 0.890,0.858,and 0.818.Compared w

关 键 词：原发性脑出血 呼吸衰竭 有创机械通气 血气指标 神经功能 撤机拔管 

分 类 号：R74[医药卫生—神经病学与精神病学]