COPD患者有创机械通气时间的相关因素研究

Study on related risk factors for duration of mechanical ventilation in patients with chronic obstructive pulmonary disease

目的探讨影响慢性阻塞性肺疾病(COPD)患者有创机械通气时间的相关因素。方法 COPD患者40例,采取有创机械通气,患者按通气时间长短分为通气短、中、长三组。详细记录患者的性别、年龄、机械通气过程中是否合并上消化道出血情况、发生腹胀情况、一年内COPD急性加重次数、入ICU时APACHEⅡ评分、体质指数(BMI)、血清生化指标、伴发病、入RICU时胸片是否有渗出病灶、撤机方式等指标。结果在众观察指标中,消化道出血、腹胀、一年内COPD急性加重次数、入ICU时APACHEⅡ评分、BMI、TP、Alb、pre-Alb、Na+、伴发病糖尿病、心功能不全、入ICU时胸片是否有渗出病灶为与通气时间相关的因素(P<0.05)。消化道出血、发生腹胀、一年内COPD急性加重次数≥2次、高APACHEⅡ评分、低BMI、低Alb、低pre-Alb、低Na+、伴发病糖尿病、心功能不全和有渗出病灶为影响COPD患者有创机械通气时间独立危险因素。结论 COPD是一个全身系统疾病,其有创机械通气时间受多种因素影响,针对这些因素采取有效措施干预,有助于缩短机械通气时间。

Objective To explore the related risk factors for duration of mechanical ventilation in patients with chronic obstructive pulmonary disease（ COPD）. Methods A total of 40 patients with COPD in this hospital were administrated with mechanical ventilation and they were divided into short,medium and long duration groups. The age range,gender ratio,digestive tract bleeding and abdominal distension during mechanical ventilation,times of acute exacerbation in one year,APACHEⅡscores before entering ICU,BMI,serum biochemical indices,complications,exudative lesions and extubating way were recorded in detail. Results Among these indices,digestive tract bleeding and abdominal distension during mechanical ventilation,times of acute exacerbation in one year,APACHEⅡscores before entering ICU,BMI,total protein（ TP）,albumin（ Alb）,pre-albumin（ pre-Alb）,Na^＋,accompanied with diabetes and cardiac insufficiency and complications were proved to be related factors for duration of mechanical ventilation. Digestive tract bleeding and abdominal distension during mechanical ventilation,acute exacerbation more than 2 times in one year,high APACHEⅡscores before entering ICU,low BMI,low Alb,pre-Alb,Na^＋,accompanied with diabetes and cardiac insufficiency and complications were independent risk factors for long duration of mechanical ventilation. Conclusion COPD is a systemic disease,and the duration of mechanical ventilation is influenced by many factors,which should be taken into comprehensive consideration. Correlated measures should be taken to reduce the duration for mechanical ventilation.