34例医院获得性肺炎患者呼吸机撤离困难原因分析

Analysis of difficult weaning of 34 patients with hospital acquired pneumonia

目的探讨影响医院获得性肺炎患者困难撤机的因素。方法回顾性分析郑州人民医院RICU2008年1月-2011年6月收治的127例行有创机械通气治疗的医院获得性肺炎患者的临床资料,将患者分为简单撤机组和困难撤机组,观察患者年龄、氧合指数、APACHEⅡ评分、血清前白蛋白、转铁蛋白、致病菌以及合并症对呼吸机撤离的影响。结果共有34例患者发生呼吸机撤离困难,困难撤机组患者的年龄、APACHEⅡ评分明显高于简单撤机组(P<0.001);其氧合指数、血清前白蛋白、转铁蛋白含量明显低于简单撤机组;其鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌感染率明显高于简单撤机组(P<0.005);且常合并较严重的基础疾病。结论肺部感染控制不理想、营养不良、心功能不全可能是影响医院获得性肺炎患者撤机困难的主要因素。

【Objective】To explore the factors influencing difficult weaning from mechanical ventilation.【Methods】A retrospective study was performed on the clinical data about hospital acquired pneumonia of 127 patients who were admitted to RICU of people＇s hospital of Zhengzhou from January 2008 to June 2011. The patients were divided into simple weaning group and difficult weaning group. The influence of age, oxygenation index, APPCHEⅡ value, the concentration of serum transferrin and prealbumin, pathogenic bacteria and accompanying diseases to weaning was studied. 【Results】34 patients underwent difficult weaning. The patients in difficult weaning group were older than that in simple weaning group（P〈0.001）. The oxygenation indices and APACHE Ⅱ value of difficult group were higher than that of simple weaning group（P〈0.001）. The concentration of serum transferrin and prealbumin of difficult weaning group was lower than that in simple weaning group（P〈0.001）. The infection rate of Acinetobacter baumannii, Pseudomonas aeruginosa and staphylococcus aureus was higher than that of simple weaning group（P〈0.005）. The difficult weaning group was often accompanied severe basic diseases.【Conclusions】It is suggested that incompletely controlled pulmonary infection, malnutrition and heart dysfunction may be the mainly factors that lead to difficult weaning from mechanical ventilation for the patients who suffer from hospital acquired pneumonia.