长期机械通气患者的预后因素分析  

Analysis of prognostic factors in patients requiring long-term mechanical ventilation

作　　者：黄伟[1] 李晓枫[2] 万献尧[1] 张久之[1] 

机构地区：[1]大连医科大学附属第一医院中心ICU科,辽宁大连116011 [2]大连医科大学流行病学教研室

出　　处：《中国呼吸与危重监护杂志》2004年第3期167-169,共3页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的　了解重症监护病房 (ICU)长期机械通气 (≥ 7d ,LTMV)患者的预后影响因素。方法　根据出院结果将 2 0 0 1年 4月～ 2 0 0 3年 6月进入ICU的 4 6例长期机械通气患者分为死亡组和生存组 ,对入院时年龄、血气以及急性生理与慢性健康评分 (APACHEⅡ )等指标进行回顾性分析 ,对各项指标进行Logistic回归分析。结果　 2 2例 ( 4 7 8% )患者死亡 ,2 4例患者 ( 5 2 2 % )生存。生存组的中心静脉压、部分凝血活酶时间、白蛋白水平 (ALB)、血钠等理化指标以及APACHEⅡ评分显著优于死亡组 (P <0 0 5 ) ;败血症发生率较低 ,气管切开比例显著高于死亡组 (P <0 0 5 ) ,Logistic回归显示ALB(P =0 0 0 9,OR =0 793,95 %可信区间 :0 6 7～ 0 95 )和气管切开 (P =0 0 33,OR =0 2 1,95 %可信区间 :0 0 5～ 0 88)对LTMV的预后有积极影响。结论　长期机械通气患者死亡率较高 。Objective To analyze prognostic factors in patients admitted to intensive care unit (ICU) and received mechanical ventilation for more than 7 days.Methods 46 patients receiving long-term mechanical ventilation (LTMV) from April 2001 to June 2003 were divided into two groups:death group and survival group based on discharged result.Admitting clinical and physiological parameters were analyzed retrospectively by Logistic regression methods.Results Of the patients enrolled in the study,22 (47.8%) died in the ICU and 24 (52.2%) were survival.Differences in central venous pressure (CVP),actived partial thromboplastin time (APTT),level of plasma albumin,sodium and acute physiology and chronic health evaluation (APACHE Ⅱ) score between survivors and nonsurvivors were significant (P<0.05).The development of sepsis and undergoing tracheotomy were also significant difference between two groups (P<0.05).With multiple logistic regression,higher ALB level (P=0.009;OR=0.793;95% confidence interval:0.67～0.95) and undergoing tracheotomy (P=0.033;OR=0.21;95% confidence interval:0.05～0.88) were independent predictors of bettter outcome.Conclusion LTMV patients may be at high risk for ICU death.Therefore the relevant factors should be evaluated cautiously before decision-making for mechanical ventilation.

关 键 词：长期机械通气 预后 相关因素 重症监护病房 

分 类 号：R563.8[医药卫生—呼吸系统]