不同撤机组老年患者呼吸机撤离的影响因素分析

Clinical Study of Main Influential Factors of Ventilator Weaning in Different Units of the Elderly Patients with the Long-term Mechanical Ventilation

目的分析影响长期机械通气(≥10天)的老年患者(年龄≥60岁)撤机困难程度的因素,探讨撤机的策略。方法回顾性调查广西医科大学第一附属医院内科ICU长期机械通气的老年患者入院时一般情况、气管切开、原发病情况,入院第1天(d1)及第10天(d10)的生命体征(心率、血压、体温、呼吸频率、尿量等),辅助检查(血常规、肝肾功能、动脉血气等)。根据撤机的困难程度和时间将撤机成功的病人分为简单撤机组、困难撤机组、延迟撤机组,对3组资料进行对比分析。对影响长期机械通气撤机困难程度的因素进行Logistic回归分析。结果共收集72例患者,简单撤机组14例,困难撤机组27例,延迟撤机组31例,血乳酸(d10)、血浆白蛋白(d10)3组比较差异有统计学意义,两两比较发现单纯撤机组与延迟撤机组血乳酸差异有统计学意义,单纯撤机组与困难撤机组比较血浆白蛋白差异有统计学意义(P<0.05);多分类变量Logistic分析示血乳酸(d10)>2.0mmol/L是影响撤机难易程度的独立因素(OR=11.584,P<0.05)。结论 机械通气后血乳酸>2.0mmol/L是影响撤机难易程度的独立因素。

Objective To analyze the influential difficuhies that prevent elderly patient who adopt mechanical ventilation from wea- ning ventilation machines and to research into the strategies of weaning ventilation machines. Methods To review the general condition, tracheotomy and primary affection of elderly patients who received mechanical ventilation when they were sent to the ICU of Internal Medi- cine Department in the First Affiliated Hospital of Guangxi Medical University, as well as their life feature, including heart rate, blood pressure, body temperature, breath frequency and urinary volume, and results of accessory examinations, including routine blood test, liv- er and kidney function examination and arterial blood gas examination, on the first day（ dl ） and the 10th day（dl0） in hospital. Accord-ing to machine -weaning difficulties and time, patients who were weaned from ventilation machines successfully were divided into three groups, namely the simple machine - weaning group, difficult machine - weaning group and delayed machine - weaning group. Data of these three groups were analyzed by comparison and logistic regression analysis on elements that affects the difficulty of weaning ventilation machine from patients who had received long term mechanical ventilation. Results Totally 72 patients＇ cases were collected（ 14 cases of simple machine- weaning group, 27 cases of difficult machine- weaning group, 31 case of delayed machine -weaning group）. Mean- while the comparison among three groups showed that the blood lactic acid （dl0） and plasma albumin （dl0） were significant different. Pairwise comparison results showed statistical significance in the blood lactic acid between simple machine - weaning group and delayed machine -weaning group and in the plasma albumin between simple machine -weaning group and difficult machine -weaning group（ P 〈 0.05 ）. The multiple categorical variable Logistic analysis showed that the blood lactic acid （dl0） 〉 2.0mmol/L was the independent in- fluential element （ OR = 11. 584, P 〈 0.05） affecting machine - weaning difficulty. Conclusion After adopting mechanical ventilation, blood lactic acid 〉 2.0mmol/L was the independent element affecting machine - weaning difficulty.