老年COPD急性加重期患者自主呼吸试验通过后拔管失败原因分析

Causes of Extubation Failure in Elderly Patients With Acute Exacerbation of COPD Following A Successful Spontaneous Breathing Trial

目的：分析老年COPD急性加重期（ AECOPD）机械通气患者拔管失败原因，总结经验以提高撤机成功率。方法回顾性分析2014年1—12月大同煤矿集团总医院收治的AECOPD并呼吸衰竭行有创机械通气且通过自主呼吸试验（ SBT）后拔管失败12例患者的临床资料，分析其拔管失败原因。结果因呼吸系统原因导致拔管失败7例，其中咳痰无力4例，呼吸肌负荷过高2例，于拔管后24 h内重新插管；大气道梗阻1例，于拔管后30 min内重新插管。因心血管系统导致拔管失败2例，均为左心功能不全，于拔管后24～72 h重新插管。因全身营养状况不良导致拔管失败2例，于拔管后48～72 h重新插管。因中枢神经系统原因导致拔管失败1例，拔管48 h后行颅脑CT确诊为脑梗死。结论 SBT指导撤机存在局限性，了解撤机过程中各种失败的原因，并进行针对性预处理，可降低AECOPD患者再插管概率。

Objective To analyze the causes of extubation failure in elderly AECOPD patients receiving mechanical ventilation and increase the rate of extubation success by drawing from previous lessons. Methods A retrospective study was conducted on 12 cases of elderly patients with AECOPD and respiratory failure who received invasive mechanical ventilation and underwent extubation failure following a successful spontaneous breathing trial. The cases were collected from General Hospital of Datong Minal Group Company between January and December in 2014. The causes of extubation failure were investigated. Results The cause of 7 cases was respiratory system dysfunction, among which 4 cases were due to the impotence of expectoration and 2 cases were due to the excessive burden of respiratory muscle,with re-intubation made within 24 hours after extubation;one case was induced by central airway obstruction,with re-intubation made within 30 minutes after extubation. Two cases were induced by the dysfunction of cardiovascular system,and the specific cause was left ventricular dysfunction,with re-intubation made between 24 and 72 hours after extubation. Two cases were induced by malnutrition,with re -intubation made between 48 and 72 hours after exturbaton. One case was induced by the dysfunction in central nervous system, with cerebral infarction diagnosed by craniocerebral CT at 48 hours after extubation. Conclusion SBT has limitation in guiding extubation. The causes of extubation failure should be noted for pertinent precautions,in order to decrease the re-intubation rate in patients with AECOPD.