影响呼吸重症监护病房慢性阻塞性肺病患者机械通气时间的因素

Risk Factors in Relation to the Time of Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Diseases in Respiratory Intensive Care Unit

目的:探讨呼吸重症监护病房的慢性阻塞性肺病(COPD)患者机械通气时间分别大于7,14,21d的潜在危险因素。方法:前瞻性记录和回顾性分析患者在疾病稳定期,入住呼吸重症监护病房时及在呼吸重症监护病房期间的特征。以t检验,χ2检验和逻辑回归分析作为统计学方法。结果:63例COPD需要机械通气患者入选。其中26例患者机械通气时间小于7d,机械通气时间大于7,14,21d的患者分别为20例,8例和9例。机械通气持续时间与社区获得性肺炎,入住时基础肺功能实验结果和血气分析均无明显相关性。发生呼吸机相关性肺炎(OR:5.8;95%,CI:2-22,P=0.013)作为机械通气大于7d的独立预测因子;呼吸机相关性肺炎也是机械通气大于14d(OR:15;95%,CI:4-70,P=0.001)的危险因素;机械通气大于21d主要与入住呼吸重症监护病房时急性生理与慢性健康Ⅱ评分(OR:1.7;95%,CI:1-1.5,P=0.002)和白蛋白水平(OR:0.5,95%CI:0.27-0.61,P=0.006)相关。结论:入住时病情严重程度和入住呼吸重症监护病房后发生呼吸机相关性肺炎是COPD患者的机械通气持续时间的主要决定因素。

Objective： To determine the potential risk factors for mechanical ventilation （MV）over periods of 7,14, or 21 days respectively in patients with chronic obstructive pulmonary disease （COPD） in respiratory Intensive Care Unit（RICU）. Methods： The characteristics of patients during the stable period of their disease, on admission to RICU and during the RICU stay, were recorded prospectively and analyzed retrospectively. The statistical analysis included t test, chi-square test and logistic regression analysis. Results： A total of 63 patients with COPD requiring MV were included in the study. Twenty-six cases and 41% of the patients required MV shorter than 7 days, 20（32%）,8（13%） and 9（14%） of the patients required MV longer than 7, 14 and 21 days respectively. There were no significant relationships between the duration of MV and the presence of community-acquired pneumonia （CAP） on admission, baseline pulmonary function test results or blood gas parameters on admission. Development of ventilator-associated pneumonia （VAP; odds ratio, OR： 5.8; 95% CI： 2-22, P=0.013） were independent predictors for MV7 days. VAP was still a risk factor for MV14 days （OR： 15; 95% CI： 1-1.5,P=0.002）. On the other hand MV21 days was related with severity of the disease on admission measured by APACHE Ⅱ score （OR： 1.7; 95% CI： 1-1.5, P=0.002） and albumin levels （OR： 0.50; 95% CI： 0.27-0.61, P=0.006）. Conclusion： Severity of disease on admission and development of VAP during RICU stay are the main determinants of MV duration in patients with COPD.