重症肺炎患者的机械通气脱机的影响因素

Influential factors for mechanical ventilation offline in patients with severe pneumonia

目的:分析影响重症肺炎患者机械通气成功脱机的危险因素。方法:回顾性分析长沙市第一医院呼吸科从2011年6月至2013年12月因重症肺炎合并呼吸衰竭需要有创机械通气的患者共59例。入选患者根据最后结局分为脱机成功组(n=31)和脱机失败组(n=28)。分别记录两组患者入院开始的一般资料、实验室检查、细菌学结果。将所有指标进行单因素比较和Logistic回归分析以了解其对机械通气脱机的影响。结果:单因素分析表明:两组患者在性别与年龄上差异无统计学意义(均P>0.05),脱机成功组在吸烟人数、APACHE II评分、D-二聚体和脑尿钠肽(brain natriuretic peptide,BNP)的浓度方面明显低于失败组,差异均有统计学意义(均P<0.05)。脱机成功组在进入重症监护病房时血清白蛋白水平均高于失败组,两组间比较差异均有统计学意义(均P<0.05)。所有因素进行Logistic回归分析后表明,D-二聚体的升高、肺部CT存在肺部基础疾病、低白蛋白是重症肺炎机械通气脱机的独立的危险因素。结论:对存在低蛋白血症、高D-二聚体及肺部CT存在肺部基础疾病的重症肺炎患者进行综合评估和治疗,有利于上述患者成功脱机。

Objective: To determine the risk factors for mechanical ventilation offline in patients with severe pneumonia.Methods: The data of 59 patients, who were admit t ed to the First Hospital of Changsha because of severe pneumonia and required mechanical ventilation between June 2011 and December 2013, were reviewed retrospectively. The patients were divided into two groups: a successful weaned group(n=31) and a failure group(n=28). The patients' background, laboratory and bacteriological examinations at the beginning of mechanical ventilation were recorded. All the indexes were analyzed by univariate analysis and logistic regression analysis.Results: Univariate analysis showed that there was no significant difference in gender and age in the 2 groups(P>0.05). Smoker, APECHE II score, D-dimer and brain natriuretic peptide(BNP)concentration in the success weaned group were lower than those in the failure group. The difference between the 2 groups was significant(P<0.05). The serum albumin level in patients of the success weaned group at the time of entering respiratory intensive care unit was higher than that in the failure group, with significant difference(P<0.05). The logistic regression analysis showed that the high concentration of D-dimer, lung diseases based on thoracic CT and low serum albumin were independent risk factors for mechanical ventilation offline in severe pneumonia patients.Conclusion: The severe pneumonia patients with low albumin, high concentration of D-dimer and lung diseases should be comprehensive evaluated and receive treatment, which is beneficial to the mechanical ventilation offline.