慢性阻塞性肺疾病急性加重期患者有创机械通气脱机困难相关危险因素分析
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摘要
目的慢性阻塞性肺疾病加重期(AECOPD)患者有床机械通气脱机困难相关因素的探讨与分析。方法选取我院2016年7月～2018年7月有创通气治疗且符合脱机条件的AECOPD患者40例,撤机成功组(25例患者)为可进行自主呼吸试验(SBT)且48h后不需要进行机械通气的患者,撤机失败组(15例患者)为不能通过SBT或通过SBT 48h仍旧需要进行机械通气的患者,回顾性分析比较两组患者临床评估指标并分析危险因素。结果撤机成功组APACHEH评分(急性生理及慢性健康评分)、BNP、PH值、血糖、CRP(C反应蛋白)、PCT(降钙素原)明显低于撤机失败组,撤机失败组中脓毒症(40.00%)、低蛋白血症(66.67%)、心力衰竭(93.33%)、糖尿病(86.68%)发生率明显高于撤机成功组脓毒症(16.00%)、低蛋白血症(40.00%)、心力衰竭(16.00%)、糖尿病发生率(48.00%),Logistic分析发现低蛋白血症、心力衰竭、糖尿病为撤机失败的危险因素,差异有统计学意义(P <0.05)。结论撤机失败的危险因素包括低蛋白血症、心力衰竭、糖尿病等,除了评估患者呼吸参数还要注重基础疾病的评估,从而增加脱机的成功概率。
Objective To explore and analyze related factors of difficult weaning from invasive mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods 40 AECOPD patients who treated with invasive mechanical ventilation and met the conditional of weaning in our hospital from July 2016 to July 2018 were selected. 25 patients who underwent spontaneous breathing test(SBT) and did not need mechanical ventilation after 48 hours of weaning were set as the successful weaning group. 15 patients who didn't pass SBT or passed SBT but sill with the need for mechanical ventilation after 48 hours of weaning were set as the unsuccessful weaning group. Results APACHEH score(acute physiological and chronic health evaluation score), BNP, PH value,blood glucose, CRP(c-reactive protein) and PCT(procalitonin) in the successful weaning group were significantly lower than those in the unsuccessful weaning group. The incidence of sepsis, hypoproteinemia, heart failure, and diabetes in the unsuccessful weaning group was respectively 40.00%, 66.67%, 93.33% and 86.68%, significantly higher than that in the successful weaning group 16.00%, 40.00%, 16.00% and 48.00%. Logistics analysis showed that hypoproteinemia, heart failure and diabetes were risk factors for weaning failure, and there was statistical significance(P < 0.05). Conclusion Risk factors for weaning failure include hypoproteinemia, heart failure and diabetes. In addition to evaluating the patient's respiratory parameters, the assessment of the underlying disease should also be emphasized to increase the success rate of weaning.
Objective To explore and analyze related factors of difficult weaning from invasive mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods 40 AECOPD patients who treated with invasive mechanical ventilation and met the conditional of weaning in our hospital from July 2016 to July 2018 were selected. 25 patients who underwent spontaneous breathing test(SBT) and did not need mechanical ventilation after 48 hours of weaning were set as the successful weaning group. 15 patients who didn't pass SBT or passed SBT but sill with the need for mechanical ventilation after 48 hours of weaning were set as the unsuccessful weaning group. Results APACHEH score(acute physiological and chronic health evaluation score), BNP, PH value,blood glucose, CRP(c-reactive protein) and PCT(procalitonin) in the successful weaning group were significantly lower than those in the unsuccessful weaning group. The incidence of sepsis, hypoproteinemia, heart failure, and diabetes in the unsuccessful weaning group was respectively 40.00%, 66.67%, 93.33% and 86.68%, significantly higher than that in the successful weaning group 16.00%, 40.00%, 16.00% and 48.00%. Logistics analysis showed that hypoproteinemia, heart failure and diabetes were risk factors for weaning failure, and there was statistical significance(P < 0.05). Conclusion Risk factors for weaning failure include hypoproteinemia, heart failure and diabetes. In addition to evaluating the patient's respiratory parameters, the assessment of the underlying disease should also be emphasized to increase the success rate of weaning.
引文
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[12]李红,贾晓慧,王士芸.对机械通气患者在行脱机实验过程中开展心理护理的临床研究[J].中国妇幼健康研究,2017(S2):206-207.
[13]Fei Dongsheng,Yang Suo Zhu,Pan Daozuo,et al.Comparison of the effects of different closed-loop ventilation modes on weaning of chronic obstructive pulmonary disease[J].Chinese Journal of Geriatrics,2015,35(23):6816-6818.
[14]李纾,安友仲,任景怡,等.影响腹部外科术后重症患者脱离机械通气的心血管因素及非心血管因素分析[J].北京大学学报(医学版),2014,46(6):911-916.
[15]曲茂兴,于健.重症监护病房撤机困难患者短期预后及相关因素分析[J].广东医学,2016,37(19):2945-2947.
[16]翟文庆,刘强,张绍权,等.慢性阻塞性肺疾病急性加重期患者机械通气撤机失败的可能性因素分析[J].中外医学研究,2018,16(14):4-7.
[2]高戈,冯喆,常志刚,等.2012国际严重脓毒症及脓毒性休克诊疗指南[J].中华危重病急救医学,2013,25(8):501.
[3]Zong Liyong,Kou Huiling,Gong Xiujun.The related factors of mechanical ventilation difficulty weaning in COPDpatients[J].Journal of Binzhou Medical College,2014,37(4):256.
[4]Society of Cardiovascular Diseases,Chinese Medical Association,etc.Guidelines for Diagnosis and Treatment of Heart Failure,China 2014[J].Chinese Journal of Cardiovascular Diseases,2014,42(2):3.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华内分泌代谢杂志,2014,30(10):26.
[6]董京生,崔丽英,成忠红,等.慢性阻塞性肺疾病急性加重期伴重度呼吸衰竭患者有创机械通气成功撤机拔管的影响因素研究[J].实用心脑肺血管病杂志,2015,23(11):20-24.
[7]Chen Gaoke,Yuan Bingbin,Chen Weipeng,et al.Observation on the efficacy of budesonide combined with compound ipratropium bromide aerosol inhalation in the treatment of acute exacerbation of chronic obstructive pulmonary disease[J].China Medical Innovation,2014,11(21):77-79.
[8]Chen Hongju.Influencing factors of withdrawal of invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure[J].Chinese Medical Innovation,2016,13(6):48-51.
[9]朱江,周娟.导致呼吸机依赖相关因素及预防对策[J].临床肺科杂志,2015,20(10):1845-1847.
[10]李蕾.急性左心衰竭有创机械通气治疗撤机困难的原因分析[J].江苏医药,2016,42(5):586-587.
[11]刘龙,是若春,宋晓军,等.重症监护病房老年患者撤机失败的影响因素[J].广东医学,2014,35(12):1902-1904.
[12]李红,贾晓慧,王士芸.对机械通气患者在行脱机实验过程中开展心理护理的临床研究[J].中国妇幼健康研究,2017(S2):206-207.
[13]Fei Dongsheng,Yang Suo Zhu,Pan Daozuo,et al.Comparison of the effects of different closed-loop ventilation modes on weaning of chronic obstructive pulmonary disease[J].Chinese Journal of Geriatrics,2015,35(23):6816-6818.
[14]李纾,安友仲,任景怡,等.影响腹部外科术后重症患者脱离机械通气的心血管因素及非心血管因素分析[J].北京大学学报(医学版),2014,46(6):911-916.
[15]曲茂兴,于健.重症监护病房撤机困难患者短期预后及相关因素分析[J].广东医学,2016,37(19):2945-2947.
[16]翟文庆,刘强,张绍权,等.慢性阻塞性肺疾病急性加重期患者机械通气撤机失败的可能性因素分析[J].中外医学研究,2018,16(14):4-7.