老年患者机械通气与胸腔积液关系的初步探讨

An investigation of pleural effusion in elderly patients receiving mechanical ventilation

目的探讨机械通气(MV)引发老年患者胸腔积液的相关病因和对血流动力学的影响机制。方法分析100例老年患者行MV的临床资料,对用MV前、后发生胸腔积液的病因进行Logistic回归分析。对其中8例患者在用MV前、后进行了超声心动图检查。结果用MV前已有27例发生胸腔积液(占27%),用MV后新增加胸腔积液者33例。用MV者共60例合并胸腔积液(占60%)。Logistic回归分析显示心功能不全是用MV后发生胸腔积液的主要因素。超声心动图显示MV使三尖瓣跨膜压增大。结论老年患者应用MV后,胸腔积液者增多,MV引起的血流动力学改变和三尖瓣跨膜压增大,使原有心功能不全者成为发生胸腔积液的重要危险因素。

Objective To investigate the cause of pleural effusion in elderly patients on mechanical ventilation, and to analyze the effect of mechanical ventilation on hemodynamics. Methods 100 elderly patients admitted to our hospital from Jan 2002 to Oct 2004 who had received mechanical ventilation were studied retrospectively and logistic regression analysis of risk factors of pleural effusion before and after mechanical ventilation were performed. 8 patients of them were examined by ultrasonic cardiography before and during mechanical ventilation. Results Before mechanical ventilation there were 27 patients complicated with pleural effusion. After mechanical ventilation another 33 patients were showed to develop pleural effusion. Totally 60 mechanical ventilated patients had pleural effusion. The analysis of logistic regression showed that cardiac insufficiency was significantly correlated with pleural fluid in the patients receiving mechanical ventilation. The transmemhrane pressure of tricuspid valve was increased during mechanical ventilation,Conclusion Incidence of pleural effusion increased, hemodynamics changed and the transmernbrane pressure of tricuspid valve increased with mechanical ventilation in the elderly patients. Cardiac insufficiency was an important risk factor of pleural effusion.