有创机械通气治疗老年慢性阻塞性肺病患者院内病死率的相关因素分析

In-hospital Survival of Older Patients Treated with Mechanical Ventilation for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:探讨接受机械通气治疗的老年慢性阻塞性肺疾病(COPD)患者院内病死率的影响因素。方法:采用回顾调查方法,将2004年1月—2007年6月河北医科大学第二医院呼吸科收治的接受有创机械通气的老年COPD患者93例,分为存活组和病死组,对临床资料进行统计学分析。结果:对老年患者存活组和病死组临床资料的分析发现,在两组之间治疗后血清白蛋白水平、基础疾病、并发多器官功能障碍综合征(MODS)、下呼吸道分泌物真菌培养阳性比较差异均有统计学意义,分别为(37.37±5.08)g·L-1比(34.86±5.60)g·L-1,88.7%比95.0%,5.7%比40.0%及24.5%比45.0%;进一步多因素Logis-tic回归分析发现,并发MODS是影响机械通气老年COPD患者生存的独立危险因素,其比值比(OR)值为0.316。结论:接受机械通气治疗的老年COPD患者病死率较非老年患者病死率高病死率增加,合并基础疾病和并发MODS多见;MODS是接受机械通气的老年COPD患者院内病死率增加的独立危险因素。

Objective：To investigate the mortality and prognosis in mechanically ventilated older chronic obstructive pulmonary disease （COPD） patients in Respiratory Intensive Care Unit. Methods：Retrospectively study was conducted on 93 patients ageel ≥60 y with suspected COPD admitted to the intensive care unit between from January 2004 to June 2007. All the patients were divided into two groups, survivals and death group. Variables in two groups potentially related to mortality were analyzed. Resuits： There were significant difference in serum albumin, Co-morbidity, multiple organ dysfunction syndrome（MODS）, fungi infection in the lower respiratory tract within survival and death group of older patients. Using multivariate logistic analysis, hospital mortality of older patients correlated positively with MODS. Conclusion： MODS are the independent risk factors of hospital mortality for the mechanical ventilated elder patients with acute exacerbation of COPD.