机械通气患者的预后影响因素分析

Analysis of Prognostic Factors in Patients Requiring Mechanical Ventilation

目的 了解机械通气患者的预后影响因素。方法 将进入ICU的 91例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 ,并对各项指标进行Logistic回归分析。结果 48例(5 2 7% )患者死亡 ,43例患者 (4 7 3 % )生存。单因素分析中 ,两组总住院时间、ICU内住院时间、部分凝血活酶时间、红细胞计数、血红蛋白量、血糖以及APACHEⅡ评分等指标具有显著性差异 (P <0 0 5 ) ,同时生存组气管切开比例显著高于死亡组 (P <0 0 5 ) ,多因素Logistic回归显示总住院时间 (P =0 0 3 3 ;OR值 0 966;95 %可信区间 :0 93 7～ 0 997)对机械通气的预后有积极的影响 ;而血糖水平 (P =0 0 0 4;OR值 1 13 8;95 %可信区间 :1 0 43～ 1 2 41)和APACHEⅡ评分 (P =0 0 2 2 ;OR值 1 0 90 ;95 %可信区间 :1 0 13～1 174)则是机械通气不良预后的危险因素。结论 机械通气增加了院内死亡率 ,患者总住院时间、血糖水平和疾病APACHE评分是判断机械通气预后的独立因素。

Objective To investigate prognostic factors in patients receiving mechanical ventilation. Methods 91 patients receiving mechanical ventilation from Jan 2002 to May 2004 were divided into two groups: death group and survival group. The patients' clinical data were retrospectively analyzed by Logistic regression method. Results Of the 98 patients, 48 cases (52.7%) died in the ICU, and 43 cases (47.3%)were survival. By means of single factor analysis, differences in total hospitalized time, time stayed in ICU,active partial thromboplastin time, red cell count, the level of haemoglobin and blood glucose, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores between the two groups were significant (P<0.05). The patients underwent tracheotomy in the survival group was also significantly higher than that in the death group (P<0.05). With multiple logistic regressions analysis, the total hospitalized time (P=0.033; OR 0.966; 95% confidence interval: 0.937～0.997) was an independent predictor of benignant outcome, while the blood glucose level(P=0.004; OR 1.138; 95% confidence interval: 1.043～1.241) and APACHE scores (P=0.022; OR 1.090; 95% confidence interval: 1.013～1.174) were risk factors of poor outcome. Conclusion Mechanical ventilation increased the mortality of the patients in ICU. The total hospitalized time, blood glucose level and APACHE II scores may be independent prognosis factors of the patients receiving mechanical ventilation.