老年患者高危术后延长机械通气临床危险因素及预后分析

The clinical risk factors of prolonged mechanical ventilationand the long-term prognosis in elderly adults after high-risk surgery

目的分析老年患者高危术后延长机械通气(PMV)的临床危险因素及其远期预后。方法回顾2006年1月~2016年1月解放军总医院南楼临床部≥65岁行高危手术患者的临床资料,单因素及Logistic回归多因素分析导致患者术后PMV的临床危险因素及PMV与死亡或其他终点事件的关系。结果共入选2 886例≥65岁行高危手术的患者,其中181例(6.3%)患者发生术后PMV。PMV组冠心病、心功能不全、高血压、痴呆、慢性阻塞性肺病的患病率及急诊手术率显著高于非PMV组(2 705例)。增龄、APACHEⅡ评分、慢性阻塞性肺病、高血压和急诊手术是老年高危术后PMV的临床危险因素。PMV组患者1年病死率明显高于非PMV组患者,其1年死亡风险及再次插管、昏迷≥24 h次要终点事件的发生风险亦分别是非PMV组的3.79倍和2.18倍。结论增龄、APACHEⅡ评分、慢性阻塞性肺病、高血压和急诊手术是老年高危术后PMV及影响预后的主要危险因素,术前识别可能PMV高危人群,并制定相应预防方案,可降低患者并发症发生率及病死率。

Objective To analyze the clinical risk factors and long-term prognosis of prolonged mechanical ventilation in elderly adults after high-risk surgery. Methods The patients aged ≥ 65 years who had high-risk surgery from January 2006 to January 2016 in the South Building of Chinese PLA General Hospital were included. The clinical risk factors and outcomes of prolonged mechanical ventilation were assessed by logistic regression. Results We identified 2886 patients aged ≥ 65 years who had high-risk surgery,6.3% received prolonged mechanical ventilation during the hospitalization.Patients received prolonged mechanical ventilation had higher incidence of coronary heart disease,heart failure,hypertension,dementia,and chronic obstructive pulmonary disease than patients who did not have prolonged ventilation. Older age,higher APACHE Ⅱ score,chronic obstructive pulmonary disease,hypertension,andemergent surgery status were the clinical risk factors.The survivors who received prolonged mechanical ventilation had a higher 1-year mortality rate than patients who did not have prolonged ventilation.Patients who received prolonged ventilation had a substantially increased 1-year mortality and higher incidence ofre-tracheal intubation and unconsciousness ≥ 24 hours than the control group. Conclusion Greater knowledge of the clinical risk factors and clinical outcomes of old patientswho received prolonged mechanical ventilation was helpful to identify the high risk patients and toimprove the prognosis of these patients.