影响长期机械通气患者预后的危险因素分析

Analysis of risk factors in prognosis in patients requiring long - term mechanical ventilation

目的 探讨影响重症加强治疗病房（ICU）中长期机械通气（LTMV）患者预后的危险因素。方法 回顾性分析42例在ICU机械通气≥7d的患者人ICU时的一般情况、原发病分布、通气前生命体征、辅助检查、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和气管切开时间。根据撤机后的生存情况分为生存组和死亡组，依照设定的临床资料对两组患者进行对比分析，并进行Logistic多元回归分析。结果 生存组22例，死亡组20例。死亡组APACHEⅡ评分、校正心率（PAR）及血尿素氮（BUN）水平均明显高于生存组（P均〈0．01），气管切开时间明显晚于生存组（P〈0．05），血浆白蛋白（ALB）、血细胞比容（HCT）和血小板计数（PLT）均明显低于生存组（P〈0．05或P〈0．01）；而两组间的机械通气时间、白细胞计数（WBC）和呼吸机相关性肺炎的发生率差异均无显著性（P均〉0．05）。Logistic多元回归分析显示，气管切开时间、HCT和PLT与LTMV患者的预后呈显著相关性（P〈0．05或P〈0．01）。结论 气管切开时间、HCT和PLT是影响LTMV患者预后的主要危险因素。

Objective To analyze risk factors in patients receiving mechanical ventilation in intensive care unit （ICU）. Methods The study group consisted of 42 patients receiving mechanical ventilation for longer than 7 days. The general condition, primary diseases, the vital signs before ventilation, accessory examination, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score, and the time of tracheostomy were collected. The patients were divided into two groups of deceased or survived when the mechanical ventilation was weaned. Comparative analysis of all the data was made with Logistic multiple regression. Results Of the patients enrolled in the study, 22 （52.4 %） survived and 20 （47.6 % ） died in the ICU. Difference in clinical data between death group and survival group was significant （P〈0.05）. In death group, the APACHE I score, the pressure adjusted heart rate （PAR）, the level of blood urea nitrogen （BUN） were higher （all P〈0. 01）, while the level of plasma albumin （ALB）, the level of hemaocrit （HCT） value, the amount of platelets （PLT） were lower （P〈0.05 or P〈0.01）, and the time of tracheostomy was later compared with those of survival group （P〈0.05）. There were no significant differences in the time of mechanical ventilation, white blood cells （WBC） and incidence of ventilator- associated pneumonia （VAP） between two groups （all P〉0.05）. With Logistic multiple regression analysis, the time of tracheostomy, the levels of HCT value, the amount of PLT were correlated with requirement of long -term mechanical ventilation （LTMV） （P〈0. 05 or P〈0.01）. Conclusion The time of tracheostomy, the levels of HCT value, the amount of PLT were independent risk factors associated with patients requiring LTMV.