严重肥胖伴呼吸衰竭机械通气的死亡危险因素分析

Analysis of Risk Factors on Death of Patients with Severe Obesity Combined with Respiratory Failure by Mechanical Ventilation

目的分析严重肥胖伴呼吸衰竭患者机械通气时发病情况和呼吸支持情况,探究其死亡危险因素。方法回顾分析2007年10月—2011年10月我院收治的严重肥胖伴急性呼吸衰竭且需呼吸机机械通气23例临床资料,按出院时是否存活分成生存组和死亡组,就其发病高危因素及治疗情况进行统计学分析。结果两组基础疾病构成情况比较差异无统计学意义(P>0.05);死亡组体重和体重指数(BMI)显著高于生存组,差异有统计学意义(P<0.05)。两组气管插管率比较差异有统计学意义(P<0.05),而无创支持条件和住院时间比较差异无统计学意义(P>0.05)。无创通气2 h后生存组二氧化碳分压(PaCO2)和pH值与通气前比较差异有统计学意义(P<0.05,P<0.01),氧分压(PaO2)与通气前比较差异无统计学意义(P>0.05);死亡组PaO2、PaCO2和pH值与通气前比较差异均无统计学意义(P>0.05)。结论严重肥胖患者出现呼吸衰竭行机械通气时,体重和BMI越高死亡风险越大,无创通气2 h后PaCO2和pH值改善不明显则预后不佳,且此类患者需谨慎气管插管。

Objective To analyze the incidence and supportive treatment of patients with severe obesity combined with respiratory failure by mechanical ventilation in order to explore the risk factors on death. Methods Clinical data of 23 patients with severe obesity combined with acute respiratory failure by mechanical ventilation during October 2007 and October 2011 were retro- spectively analyzed. The patients were divided into survival group and death group based on status upon discharge. Risk factors and treatment strategies of the two groups were statistically analyzed. Results The underlying diseases of the two groups were of no significant difference （P 〉 0.05 ） ; the weight and body mass index （BMI） of the death group were significantly higher than those of survival group （P 〈0.05）. The differences in endotracheal intubation rates of two groups were statistically significant （P 〈 0.05 ）, but the support situation of non-invasive and hospitalization time were of no significant difference （P 〉 0. 05 ）. The PaCO2 and pH values before and after 2 h of noninvasive ventilation in survival group were significantly difference （ P 〈 0.05, P 〈 0.01 ）, but PaO2 change was no of significant difference （P 〉 0.05） ; the PaCO2, pH values and PaO2 before and after 2 h of noninvasive ventilation in death group was no of significant difference （P 〉 0.05）. Conclusion When severely obese patients have respiratory failure and need mechanical ventilation, the higher the body weight and BMI are, the greater the risk of death is. If PaCO2 and the pH value does not improved significantly after 2 h of noninvasive ventilation the prognosis of the patient is poor, and such patients need cautious assessment for the use of endotracheal intubation.