AECOPD合并呼吸衰竭患者有创-无创序贯撤机时再插管的相关因素分析
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摘要
目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者有创-无创序贯通气撤机时再次气管插管(再插管)的相关因素。方法回顾性分析2012年1月至2014年6月钦州市第二人民医院ICU收治的AECOPD合并呼吸衰竭行有创-无创序贯通气撤机患者的临床资料,根据患者是否需要再次插管分为再插管组(19例)和非再次插管组(120例),对可能引起再次插管的危险因素进行分析。结果咳嗽排痰能力差(OR=4.987,95%CI 1.813~11.052,P=0.003)、无创序贯通气12 h时二氧化碳分压升高(OR=7.563,95%CI 1.936~19.857,P=0.001)是导致AECOPD合并呼吸衰竭患者行有创-无创序贯通气撤机时再插管的影响因素。结论咳嗽排痰能力差和无创序贯通气12 h时二氧化碳分压升高是AECOPD合并呼吸衰竭患者行有创-无创序贯通气撤机时再次插管的危险因素。
Objective To explore the risk factors related to re-intubation of invasive and noninvasive sequential mechanical ventilation of acute exacerbation of chronic obstructive pulmonary disease( AECOPD).Methods The clinical data of 139 cases of AECOPD receiving invasive and noninvasive sequential mechanical ventilation in Intensive Care Unit of Qinzhou City Second People's Hospital from Jan.2012 to Jun.2014 were analyzed retrospectively,and the 139 cases were divided into re-intubation group( 19 cases) and non re-intubation group( 120 cases),and the risk factors related to re-intubation were analyzed.Results Poor capability of sputum exclusion( OR = 4.987,95% CI 1.813-11.052,P = 0.003),CO2 partial pressure increase after 12 h with sequential noninvasive mechanical ventilation( OR = 7.563,95% CI 1.936-19.857,P = 0.001) were the independent risk factors for re-intubation.Conclusion Poor capability of sputum exclusion and CO2 partial pressure increase after 12 h with sequential noninvasive mechanical ventilation are risk factors for re-intubation of AECOPD patients undergoing invasive and noninvasive sequential mechanical ventilation.
Objective To explore the risk factors related to re-intubation of invasive and noninvasive sequential mechanical ventilation of acute exacerbation of chronic obstructive pulmonary disease( AECOPD).Methods The clinical data of 139 cases of AECOPD receiving invasive and noninvasive sequential mechanical ventilation in Intensive Care Unit of Qinzhou City Second People's Hospital from Jan.2012 to Jun.2014 were analyzed retrospectively,and the 139 cases were divided into re-intubation group( 19 cases) and non re-intubation group( 120 cases),and the risk factors related to re-intubation were analyzed.Results Poor capability of sputum exclusion( OR = 4.987,95% CI 1.813-11.052,P = 0.003),CO2 partial pressure increase after 12 h with sequential noninvasive mechanical ventilation( OR = 7.563,95% CI 1.936-19.857,P = 0.001) were the independent risk factors for re-intubation.Conclusion Poor capability of sputum exclusion and CO2 partial pressure increase after 12 h with sequential noninvasive mechanical ventilation are risk factors for re-intubation of AECOPD patients undergoing invasive and noninvasive sequential mechanical ventilation.
引文
[1]蔡红,杨娟.有创-无创序贯通气治疗在AECOPD撤机患者中的应用[J].临床肺科杂志,2012,17(6):1015-1016.
[2]中华医学会重症医学分会.慢性阻塞性肺疾病急性加重患者的机械通气指南[J].中国危重病急救医学,2007,19(9):513-518.
[3]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版)[J].中华结核和呼吸杂志,2007,30(1):8-17.
[4]郑瑞强,刘玲,杨毅,等.有创无创序贯机械通气治疗慢性阻塞性肺病所致急性呼吸衰竭的研究[J].中华急诊医学杂志,2005,14(1):21-25.
[5]有创-无创序贯机械通气多中心研究协作组.以肺部感染控制窗为切换点行有创与无创序贯机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭的随机对照研究[J].中华结核和呼吸杂志,2006,29(1):14-18.
[6]宋宁燕,许劲松,夏国际,等.AECOPD合并Ⅱ型呼吸衰竭无创正压通气治疗早期失败的预警因素分析[J].临床肺科杂志,2011,16(10):1529-1531.
[7]陈虹,林辉斌,莫俊德.序贯性机械通气治疗慢性阻塞性肺病撤机失败患者的临床研究[J].临床肺科杂志,2009,14(1):92-93.
[8]罗祖金,詹庆元,童朝晖,等.无创正压通气治疗预测因素分析Ⅱ型呼吸衰竭失败[J].中国实用内科杂志,2011,31(4):278-281.
[9]Lopez-Campos JL,Garcia Polo C,Leon Jimenez A,et al.Staff training influence on non-invasive ventilation outcome for acute hypercapnic respiratory failure[J].Monaldi Arch Chest Dis,2006,65(3):145-151.
[2]中华医学会重症医学分会.慢性阻塞性肺疾病急性加重患者的机械通气指南[J].中国危重病急救医学,2007,19(9):513-518.
[3]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版)[J].中华结核和呼吸杂志,2007,30(1):8-17.
[4]郑瑞强,刘玲,杨毅,等.有创无创序贯机械通气治疗慢性阻塞性肺病所致急性呼吸衰竭的研究[J].中华急诊医学杂志,2005,14(1):21-25.
[5]有创-无创序贯机械通气多中心研究协作组.以肺部感染控制窗为切换点行有创与无创序贯机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭的随机对照研究[J].中华结核和呼吸杂志,2006,29(1):14-18.
[6]宋宁燕,许劲松,夏国际,等.AECOPD合并Ⅱ型呼吸衰竭无创正压通气治疗早期失败的预警因素分析[J].临床肺科杂志,2011,16(10):1529-1531.
[7]陈虹,林辉斌,莫俊德.序贯性机械通气治疗慢性阻塞性肺病撤机失败患者的临床研究[J].临床肺科杂志,2009,14(1):92-93.
[8]罗祖金,詹庆元,童朝晖,等.无创正压通气治疗预测因素分析Ⅱ型呼吸衰竭失败[J].中国实用内科杂志,2011,31(4):278-281.
[9]Lopez-Campos JL,Garcia Polo C,Leon Jimenez A,et al.Staff training influence on non-invasive ventilation outcome for acute hypercapnic respiratory failure[J].Monaldi Arch Chest Dis,2006,65(3):145-151.