AECOPD伴严重呼吸衰竭患者有创机械通气治疗及疗效影响因素分析

Analysis of influence factors on efficacy and invasive mechanical ventilation therapy in AECOPD patients with severe respiratory failure

目的探讨AECOPD伴严重呼吸衰竭患者有创机械通气治疗及疗效影响因素。方法选取2007年9月-2014年10月在本院治疗的AECOPD合并严重呼吸衰竭并行气管插管、有创机械通气治疗患者150例,依据患者是否成功拔出气管插管,撤离呼吸机分为可分为成功组（95例）和预后不良组（55例）。结果两组患者临床症状均明显缓解,口唇发绀明显改善,动脉血气分析指标与插管前比较,差异有统计学意义（P〈0.05）;但两组插管后动脉血气分析指标比较,差异无统计学意义（P〉0.05）。治疗前后两组患者的WBC,NEU及HGB比较,差异均有统计学意义（P均〈0.05）;成功组的WBC,NEU及HGB结果明显优于预后不良组,差异有统计学意义（P〈0.05）。预后不良的危险因素包括入院时HGB,拔管时WBC、NEU%、CRP、HGB、ALB,MODS及通气时间。其独立影响危险因素为治疗后NEU%、入院时HGB,ALB及通气天数。结论 AECOPD伴严重呼吸衰竭的患者采用机械通气是抢救、治疗的有效手段,患者生存期明显延长。

Objective To study the influence factors on efficacy and invasive mechanical ventilation therapy in AECOPD patients with severe respiratory failure. Methods 150 AECOPD patients with severe respiratory failure, who were treated with tracheal intubation and invasive mechanical ventilation therapy in our hospital from September 2007 to December 2014, were selected and were divided into success group（95 cases） and poor prognosis group（55 cases） according to the success or not of pull out tracheal intubation and withdrawing breathing machine. Results After treatment on the two groups, the clinical symptoms were obviously remission, the cyanosis of oral lip were obviously improvement, the analysis index of arterial blood gas was statically significant compared with anterior tracheal intubation（P〈0.05）, while the analysis index of arterial blood gas after tracheal intubation between the two groups was no statically significant（P〈0.05）. The differences of WBC, NEU, and HGB between the two groups pre and post treatment was statically significant（P〈0.05）, the results of WBC, NEU, and HGB in success group was obviously better than which in poor prognosis group, the differences was statically significant（P〈0.05）. The risk factors of poor prognosis group were HGB on admission, WBC, NEU%, CRP, HGB, ALB, MODS, and ventilation time during extubation. The independent influencing of risk factors was NEU% after treatment, HGB, ALB, and ventilation day on admission. Conclusion Invasive mechanical ventilation therapy in AECOPD patients with combined severe respiratory failure is effective means on rescue and treatment, could obviously prolonged patients＇ survival time.