COPD患者呼吸机依赖相关危险因素分析

Analysis on related risk factors of ventilator dependence in patients with COPD

目的探讨慢性阻塞性肺疾病(COPD)患者有创机械通气呼吸机依赖的相关危险因素。方法对沈阳军区总医院呼吸内科重症监护室(RICU)130例COPD患者有创机械通气的临床资料进行回顾分析。结果 130例有创机械通气患者中,发生呼吸机依赖33例,既往COPDⅢ级以上、急性加重次数每年≥3次、心功能≥3级、呼吸机相关肺炎、并发应激性溃疡、体质量指数<18与呼吸机依赖关系密切。结论行机械通气的COPD患者,应尽早脱机行有创-无创通气序贯治疗,避免发生呼吸机相关肺炎,积极改善心功能,保护胃黏膜,加强营养支持,可最大限度减少呼吸机依赖的发生。

Objective To discuss the related risk factors of ventilator dependence in patients with chronic obstructive pulmonary disease （COPD）. Methods A total of 130 COPD patients admitted to the Respiratory Intensive Care Unit （RICU） of the General Hospital of Shenyang Command were retrospectively analyzed. Results Among the 130 patients, ventilator dependence occurred in 33 ones. The factors closely related to the ventilator dependence consisted of lung function above grade III, acute exacerbation frequency equal to or more than three times every year, low heart function （ ≥ m）, ventilator associated pneumonia, complicated stress ulceration, and low body mass index （ 〈 18.5kg/m2 ）. Conclusion The prevention from ventilator dependence in the patients with COPD includes ventilating with sequential invasive-to-noninvasive ventilation, avoiding ventilator associated pneumonia, improving heart function, protecting gastric mueosa, strengthening nutritional support.