急诊ICU中序贯通气治疗AECOPD患者撤机时机及影响撤机因素的临床分析

Clinical analysis of weaning time and influencing factors of sequential ventilation for patients with AECOPD in emergency ICU

目的分析研究慢性阻塞性肺疾病急性发作(AECOPD)患者在急诊ICU中采用序贯通气治疗的撤机时机,并对影响机械通气持续时间的因素进行分析。方法对2014年11月-2016年11月我院收治的146例经序贯通气治疗的AECOPD患者进行研究,收集所有患者的一般资料、机械通气时间、急性生理学(SAPSⅡ)评分、APACHEHⅡ评分、浅快呼吸指数(RSBI)、血气分析、自主排痰能力、脑钠肽(BNP)水平、血浆前白蛋白水平(pre-ALB)、降钙素原(PCT)等相关指标,对其进行单因素分析,并将P<0.05的指标进行Logistic回归分析。结果本次研究的146例患者中撤机成功的患者共119例,其中88例(73.95%)患者为首次撤机成功。其中有创呼吸机辅助通气时间≤7d的患者103例(70.55%),通气时间>7d的患者共16例(10.96%)。单因素分析结果显示,血浆pre-ALB水平、PCT水平、BNP含量以及APACHEⅡ评分情况对患者序贯通气治疗撤机时间有显著性影响(P<0.05);而p H值、Pa CO2以及SAPSⅡ评分对其无显著性影响(P>0.05)。Logistic回归分析结果表明,ALB水平、PCT水平、BNP含量以及APACHEⅡ评分均是影响患者序贯通气治疗撤机时间的独立因素(P<0.05)。结论急诊ICU中多数采用序贯通气治疗的AECOPD患者可以在7d内撤机成功;临床治疗过程中通过综合考虑患者的RSBI、APACHEⅡ评分以及患者的自主排痰能力有利于临床选择撤机时间。

Objective To analyze the weaning time and influencing factors of sequential ventilation for patients with AECOPD in emergency ICU. Methods 146 patients with AECOPD from November 2014 to November 2016 were enrolled in this study. Their general data, mechanical ventilation time, acute physiology SAPS Ⅱ score, APACHEH Ⅱ score, RSBI, blood gas analysis, spontaneous expectoration ability, BNP, plasma pre-ALB, PCT） and other related indicators were collected and given single factor analysis. The index of P 〈0. 05 was used for logistic re-gression analysis. Results The sequential ventilation of 119 of 146 patients were successfully weaned, 88 of which were successful at the first time weaning （73. 95% ）. There were 103 cases of invasive ventilator-assisted ventilation time 〉 7d （70.55%） and 16 cases of ventilation time 〉 7 days （10.96%）. The results of univariate analysis showed that plasma pre-ALB level, PCT level, BNP content and APACHE Ⅱ score had significant effect on patients with sequential ventilation （P 〈0. 05） , while pH value, PaC02 and SAPS Ⅱ score had no significant effect （P 〉 0. 05）. Logistic regression analysis showed that ALB level, PCT level, BNP content and APACHE Ⅱ score were independent factors （ P 〈 0. 05 ） in patients with sequential ventilation. Conclusion Most patients with AECOPD underwent sequential ventilation in the emergency ICU can be weaned successfully within 7 days. In the course of clinical treatment, RSBI, APACHE Ⅱscore and the patients independent expectoration ability are beneficial to the clinical choice of weaning time.