有创机械通气治疗老年AECOPD患者撤机失败的危险因素分析  

Risk factors of withdrawal failure in elderly patients with AECOPD treated by invasive mechanical ventilation

作　　者：丁素静 党晶芸 DING Su-jing;DANG Jing-yun(Department of Geriatric Respiratory Sleeping,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院老年呼吸睡眠科,郑州450000

出　　处：《医药论坛杂志》2025年第1期49-53,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20180236)。

摘　　要：目的探讨有创机械通气治疗老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者撤机失败的危险因素,为寻求最佳撤机时机提供参依据,进而减少撤机失败的发生。方法选取郑州大学第一附属医院2022年2月至2024年4月收治的行有创机械通气治疗的老年AECOPD患者198例。根据撤机是否一次性成功将老年AECOPD患者分为撤机成功组和撤机失败组。收集两组一般资料、实验室指标和血气分析指标,采用二元logistic回归模型分析老年AECOPD患者撤机失败的主要影响因素。结果198例行有创机械通气治疗的老年AECOPD患者中,撤机失败率为27.78%(55/198)。单因素分析显示,撤机失败组和撤机成功组患者年龄、有无糖尿病、有无多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)、入院时急性生理功能和慢性健康状况评分系统Ⅱ评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、COPD病程、有创通气时间、撤机前呼吸浅快指数(rapid shallow breathing index,RSBI)、撤机前血清白细胞计数(white blood cell count,WBC)、C反应蛋白(C-reactive protein,CRP)、白蛋白(albumin,ALB)、降钙素原(procalcitonim,PCT)、氨基末端脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)水平比较,差异有统计学意义(P<0.05);二元logistic回归模型分析显示,年龄≥70岁、合并MODS、入院时APACHEⅡ评分≥20分、有创通气时间≥7 d、撤机前RSBI≥105次/(min·L)、撤机前血清CRP≥10 mg/L、ALB<30 g/L、NT-proBNP≥1200 ng/L是老年AECOPD患者撤机失败的独立危险因素(P<0.05)。结论行有创机械通气治疗的老年AECOPD患者撤机失败率较高,年龄、合并MODS、入院时APACHEⅡ评分、有创通气时间、撤机前RSBI、撤机前血清CRP、ALB、NT-proBNP水平是其撤机失败的影响因素。临床应针对上述影响因素,早期制定针对性干预措施,以寻求�Objective To investigate the risk factors of withdrawal failure in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)treated with invasive mechanical ventilation,so as to provide reference for seeking the best time for withdrawal and reduce the occurrence of withdrawal failure.Methods Totally 198 elderly AECOPD patients treated with invasive mechanical ventilation in the First Affiliated Hospital of Zhengzhou University from February 2022 to April 2024 were selected.Based on whether the machine was successfully removed at one time,patients were divided into the weaning success group and the weaning failure group.General information,laboratory indicators,and blood gas analysis indicators were collected,and the influencing factors of weaning failure of invasive mechanical ventilation in elderly AECOPD patients were analyzed by binary logistic regression model.Results Among 198 elderly AECOPD patients who underwent invasive mechanical ventilation treatment,the failure rate of weaning was 27.78%(55/198).The univariate analysis showed that there were significant differences in age,diabetes,multiple organ dysfunction syndrome(MODS),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score at admission,COPD course,invasive ventilation time,rapid shallow breathing index(RSBI)before weaning,and serum levels of white blood cell count(WBC),C-reactive protein(CRP),albumin(ALB),N-terminal pro-B-type natriuretic peptide(NT-proBNP)before weaning between the weaning failure group and the weaning success group(P<0.05).The binary logistic regression analysis showed that age≥70 years old,concomitant MODS,APACHEⅡscore at admission≥20 points,invasive ventilation time≥7 days,preoperative RSBI≥105 times/(min·L),preoperative serum levels of CRP≥10 mg/L,ALB<30 g/L and NT-proBNP≥1200 ng/L were independent risk factors for invasive mechanical ventilation failure in elderly AECOPD patients(P<0.05).Conclusion Elderly AECOPD patients undergoing invasive mechanical ventilation treat

关 键 词：慢性阻塞性肺疾病急性加重期 撤机失败 有创机械通气 影响因素 预后 

分 类 号：R563.9[医药卫生—呼吸系统]