机械通气在老年脑血管病合并呼吸衰竭患者中应用的对照研究

Clinical significance of mechanical ventilation in the treatment of cerebral vascular disease with respiratory failure:a case-control study

目的研究机械通气在脑血管病合并呼吸衰竭中的作用。方法118例8年间连续进入急诊的36～99岁的脑血管合并呼吸衰竭患者接受机械通气,其中78例年龄≥65岁者用作通气组。以同期就诊于急诊的有机械通气指征但拒绝机械通气治疗的脑血管合并呼吸衰竭患者(均≥65岁)为对照组,比较两组的病情严重程度、APACHEⅡ评分、存活时间、费用、支付方式和预后等各方面的差异。结果①两组患者在年龄、性别分布和APACHEⅡ评分方面无显著差异(均P>0.05),两组患者有可比性。②两组患者住院时间、病死率差异无统计学意义(P>0.05)。③机械通气组医疗费用为(38659～78468)元,明显高于非机械通气组[(19863～48321)元,P<0.05]。④通气组患者享受公费医疗的比例为96.2%(75/78),显著高于对照组(79%,93/118,P<0.05)。结论需要机械通气辅助呼吸的脑血管患者预后极差,大于65岁患者组接受机械通气后仅延长住院时间,不能提高存活率,而且医疗费用明显增加。

Objective To investigate the value of mechanical ventilation in treatment of cerebral vascular disease （CVD） with respiratory failure. Methods 110 CVD patients with respiratory failure, aged 36-99, consecutively admitted in the ICU dur ing 8 years underwent mechanical ventilation, and 78 of them aged≥65 （with an average age of 74.6±6.4） were used as ventilation group. 118 CVD patients with respiratory failure treated in the same ICU and in the same period, aged 76.6±7.3 （65-94）, who had the indication of ventilation but refused it were used as control group. Relevant data, including the demographical data, medical expenses, payment means, family economic condition, underlying diseases, vital signs, blood gas analysis results, APACHE Ⅱ score, hospitalization time, ventilation time, and outcome, etc., were analyzed. Results （1） There is no significant differences in age, gender, and APACHE Ⅱ score of between the two groups （all P 〉0.05）. （2） Therewerenosignificantdifferences in hospitalization days and mortality between thetwo groups （both P 〉0.05）. The APACHE Ⅱ scores of the patients in both groups were 20-42,and the 46 cases with the scores〉30 all failed to survive. （3）The average medical expense of the ventilation group was （38 659±39 809）yuan, much more greater than that of the control group [（19 863±28 458） yuan]. （4） The proportion of those enjoying medical services at state expense of the ventilation group was 96.2% （75/78）, significantly higher than that of the control group （79%,93/118,P 〈0.05）. Conclusion The outcome of the CVD patients treated by ventilation is poor. The patients aged ≥65 cannot get benefit from ventilation, and the cost of ventilation is much more enormous.