老年慢性阻塞性肺疾病急性加重期伴呼吸衰竭患者机械通气疗效及其影响因素  

Efficacy of mechanical ventilation and its influencing factors in patients with acute exacerbation of chronic obstructive pulmonary disease complicated by respiratory failure

作　　者：马竞驰 张丽 季学丽 赵青 Ma Jingchi;Zhang Li;Ji Xueli;Zhao Qing(Emergency Room,First Affiliated Hospital of Nanjing Medical University,Jiangsu Provincial People′s Hospital,Nanjing 210000,China)

机构地区：[1]南京医科大学第一附属医院·江苏省人民医院急诊室,南京210000

出　　处：《中华老年多器官疾病杂志》2025年第2期87-92,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家重点研发计划(2020YFC0848100);国家自然科学基金(81772779)。

摘　　要：目的探究老年慢性阻塞性肺疾病急性加重期(AECOPD)伴呼吸衰竭患者机械通气疗效及其影响因素。方法回顾性分析2022年6月至2023年6月南京医科大学第一附属医院·江苏省人民医院急诊抢救室收治的老年AECOPD伴呼吸衰竭患者160例,均采用有创-无创序贯机械通气治疗,并分析临床疗效及治疗前、治疗24 h肺功能与血气指标变化情况。采用SPSS 26.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ^(2)检验。采用单因素及多因素logistic回归分析患者机械通气疗效的独立影响因素。结果160例患者均接受有创-无创序贯机械通气治疗,其中116例(72.50%)通气成功并撤机(通气成功组),44例(27.50%)通气失败(通气失败组)。160例患者机械通气治疗24 h用力肺活量(FVC)、呼气峰值流量(PEF)、第1秒用力呼气容积(FEV1)、pH、动脉血氧分压(PaO_(2))较治疗前升高,心率(HR)、动脉血二氧化碳分压(PaCO_(2))较治疗前降低,差异均有统计学意义(P<0.05)。logistic回归分析结果显示,年龄≥70岁(OR=1.589,95%CI 1.210~2.087)、糖尿病(OR=2.257,95%CI 1.319~3.862)、多器官功能障碍综合征(MODS;OR=4.710,95%CI 2.580~8.598)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分≥19分(OR=22.280,95%CI 2.538~195.586)、PaO_(2)<55 mmHg(1 mmHg=0.133 kPa;OR=8.712,95%CI 2.220~34.189)和PaCO_(2)≥75 mmHg(OR=25.800,95%CI 4.703~141.535)是老年AECOPD伴呼吸衰竭患者机械通气疗效的独立影响因素(P<0.05)。结论老年AECOPD伴呼吸衰竭患者接受有创-无创序贯机械通气治疗可获取良好疗效,能够改善缺氧症状及肺功能,但年龄、糖尿病、MODS、APACHEⅡ评分、PaO_(2)和PaCO_(2)是其疗效的独立影响因素,需在临床应用中予以关注。Objective To explore the efficacy of mechanical ventilation and its influencing factors in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated by respiratory failure.Methods A retrospective analysis was made of a total 160 elderly AECOPD patients with respiratory failure admitted to the First Affiliated Hospital of Nanjing Medical University,Jiangsu Provincial People′s Hospital from June 2022 to June 2023.All patients were treated with invasive-noninvasive sequential mechanical ventilation.The clinic efficacy,and changes in lung function and blood gas indicators before and 24 hours after treatment were analyzed.SPSS 26.0 was used for statistical analysis.Data comparison between two groups was performed using t test orχ^(2)test depending on data type.Univariate and multivariate logistic regression were used to analyze the independent factors influencing the efficacy of mechanical ventilation.Results All 160 patients received invasive non-invasive sequential mechanical ventilation treatment,of whom 116(72.50%)were successfully ventilated and weaned off(successful ventilation group),and 44(27.50%)failed to ventilate(failed ventilation group).In all patients treated with mechanical ventilation for 24 h forced vital capacity(FVC),peak expiratory flow(PEF),forced expiratory volume in one second(FEV1),pH and arterial oxygen partial pressure(PaO_(2))were higher than those before treatment,the heart rate(HR)and arterial partial pressure of carbon dioxide(PaCO_(2))were lower after treatment,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that age≥70 years(OR=1.589,95%CI 1.210-2.087),diabetes mellitus(OR=2.257,95%CI 1.319-3.862),multiple organ dysfunction syndrome(MODS)(OR=4.710,95%CI 2.580-8.598),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score≥19 points(OR=22.280,95%CI 2.538-195.586),PaO_(2)<55 mmHg(OR=8.712,95%CI 2.220-34.189),and PaCO_(2)≥75 mmHg(OR=25.800,95%CI 4.703-141.535)were independent influen

关 键 词：老年人 慢性阻塞性肺疾病急性加重期 呼吸衰竭 机械通气 影响因素 

分 类 号：R563.8[医药卫生—呼吸系统]