有创机械通气治疗慢性阻塞性肺疾病急性加重期患者撤机困难相关影响因素分析

Influencing Factors of Weaning Difficulty in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Treated by Invasive Mechanical Ventilation

目的探讨有创机械通气治疗的慢性阻塞性肺疾病急性加重期(AECOPD)患者撤机困难相关影响因素。方法选取2012年2月-2016年3月我院收治的92例AECOPD患者作为研究对象,所有患者均进行有创机械通气治疗,将其中出现撤机拔管困难或死亡的患者纳入观察组,未出现撤机拔管困难的患者纳入对照组,采用多因素Logistic回归性分析AECOPD患者有创机械通气治疗出现撤机拔管困难的相关影响因素。结果 2组患者性别、既往有无吸烟史、PaO_2、PaCO_2、SaO_2、pH值、WBC、Hb、CRP、ALB进行比较,差异无统计学意义(P>0.05)。2组年龄、拔管时WBC、Hb、CRP、ALB、通气时间进行比较,差异有统计学意义(P<0.05)。年龄、拔管时WBC、拔管时CRP、通气时间均是AECOPD患者有创机械通气治疗撤机困难的影响因素。结论临床医生严格掌握其影响因素可以有效地减少AECOPD患者撤机拔管的失败率,从而提高AECOPD患者进行有创机械通气治疗的安全性。

Objective To investigate the influencing factors of weaning difficuhy in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） treated with invasive mechanical ventilation. Methods A total of 92 AECOPD patients admitted to our hospital from February 2012 to March 2016 were enrolled in this investigation. All the patients had been treated with invasive mechanical ventilation. The patients who had had difficulty in weaning or died were included in the observa- tion group while those had not were included in the control group. Multivariate logistic regression analysis was used to analyze the influencing factors of difficulty in weaning and extubation in AECOPD patients with invasive mechanical ventilation. Results No significant difference was detected in gender, smoking history, PaO2, PaCO2, Sa02, pH before intubation, WBC, Hb, or CRP before intubation between the two groups （P〉0. 05）. However, significant difference was detected between the two groups in age, WBC, Hb, and CRP during extubation,ALB and ventilation time after extubation （P〈0. 05 ）. Age, CRP during extubation and ventilation time were the influencing factors of difficulty in weaning for AECOPD patients on mechanical ventilation. Conclusion Clinicians ought to strictly control the influencing factors,which can effectively reduce the extubation failure rate of AECOPD patients and en- hance the safety of patients on invasive mechanical ventilation.