高龄老年患者270例机械通气后短期预后及危险因素分析

Risk factors and short-term prognosis in patients of advanced age after mechanical ventilation：analysis of 270 cases

目的：对行机械通气的老年患者进行随访观察，分析机械通气的短期预后及危险因素。方法选择2008年1月至2013年6月就诊于解放军总医院老年病房的270例机械通气患者为研究对象，根据机械通气后28d时和29d至3个月时患者的生存情况，将患者资料分成死亡组（n＝126）和存活组（n＝144）进行分析，采用单因素分析筛查出影响预后的因素，以有统计学意义的因素作为自变量进行多因素logistic回归分析，判断各因素对死亡风险的影响。结果270例老年机械通气患者，年龄（89.0±4.8）岁。肺炎（70.7%）为最常见病因，其次为急性左心衰（10.7%）和慢性阻塞性肺疾病急性加重（AECOPD，7.8%）等。28d内死亡86例（31.9%），3个月内共死亡126例（46.7%）。多因素logistic回归分析显示低氧合指数（PO2/FiO2）、前白蛋白降低、血尿素氮（BUN）增高、血清肌酐（SCr）增高（〉165.2μmol/L）、使用呼气末正压（PEEP）是影响机械通气患者28d预后的危险因素（均P＜0.05）；慢性肾脏病（CKD）、C-反应蛋白（CRP）是影响机械通气患者29d至3个月时预后的危险因素（均P＜0.05）。结论肺炎、急性左心衰、AECOPD等是老年患者机械通气最常见的原因；CKD、低PO2/FiO2、前白蛋白降低、CRP、BUN增高、SCr增高（＞165.2μmol/L）及使用PEEP是影响机械通气患者预后的危险因素。

Objective To investigate the risk factors and short-term outcome in very old patients undergoing mechanical ventilation. Methods A total of 270 very old patients undergoing mechanical ventilation in geriatric departments of Chinese PLA General Hospital from January 2008 to June 2013 were enrolled in this study. All the patients were divided into death group （n=126） and survival group （n=144） according to their outcomes in 28d, and from 29d to 3 months after mechanical ventilation. Univariate analysis was used to explore the related factors for prognosis from clinical data. Multivariate logistic regression analysis was carried out to determine the risk factors for death in these patients after mechanical ventilation. Results The cohort of patients was at the age of （89.0±4.8） years. Pneumonia （70.7%） was the major cause of mechanical ventilation. The other causes were acute heart failure （10.7%） and chronic obstructive pulmonary disease with acute exacerbation （AECOPD, 7.8%）. There were 86 cases （31.9%） died within 28d after mechanical ventilation, and 126 cases （46.7%） died within 3 months. Multivariate logistic regression analysis revealed that low oxygenation index （PO2/FiO2）, low serum pre-albumin, increased blood urea nitrogen （BUN）, high serum creatinine （SCr〉165.2μmol/L）, and using positive end-expiratory pressure （PEEP） were the prognostic factors in those patients who died within 28d after mechanical ventilation （all P〈0.05）. Chronic kidney disease （CKD） and the level of C-reactive protein （CRP） were the prognostic factors in those patients died from 29d to 3 months after mechanical ventilation （P〈0.05）. Conclusion Pneumonia, acute heart failure and AECOPD are common causes of mechanical ventilation in elderly patients. CKD, low PO2/FiO2, low serum pre-albumin, CRP, increased BUN, high Scr （〉165.2μmol/L） and using PEEP are the prognostic factors in the elderly patients with mechanical ventilation.