重症监护病房中长期机械通气患者的死亡危险因素分析

Risk Factors of Death in Patients with Long-term Mechanical Ventilation in Intensive Care Unit

目的分析重症监护病房 （ ICU）中长期机械通气患者的死亡危险因素.方法选取本院 ICU 2 0 1 3年 6 月- 2015 年 9 月收治的长期机械通气患者 7 4例,按照患者撤机后生存与否分为两组,分别为生存组与死亡组,比较两组患者的基本 临床资料.结果 死亡组患者年龄高于 6 5 岁者、有心功能不全并发症、有高血压并发症、营养不良、多器官功能不全综合征、 呼吸机相关性肺炎、消化道出血、肾功能不全、肝功能不全、神经系统并发症者占比均明显高于存活组 （ P〈0 . 0 5 ） ,且死亡组 患者机械通气时间、气管切开时间均明显比对照组长 （ P〈0. 0 5 ） ,血屎素氮水平明显高于存活组,血清白蛋白水平明显低于 对照组 （ P〈0. 05）. 经非条件 Logistic回归分析,结果发现,年龄、机械通气时间、低白蛋白水平、气管切开时间为长期机械 通气患者死亡的危险因素.结论年龄、机械通气时间、气管切开时间、低白蛋白水平、有其他合并症、高血屎素氮等是重症 监护病房长期机械通气患者死亡危险因素,临床医师应对这些危险因素给予高度注意并注意防治,减少机体损害,促使机械 通气的成功率升高,从而减少患者死亡率.

Objective To investigate the risk factors of death in patients with medium and long term mechanical ventila-tion in intensive care unit （ICU）. Methods A total of 74 patients underwent long-term mechanical ventilation from June 2013 to September 2015 were divided into the survival group and death group according to survival after withdrawal. The clinical data were compared between the two groups. Results The aged more than 65 years, heart failure, hypertension, malnutrition, multiple organ dysfunction syndrome, ventilator-associated pneumonia, gastrointestinal bleeding, renal insufficiency,liver dysfunction, neurological complications in the death group were significantly higher than those in the survival group （P〈C 0. 05）. Mechanical ventilation time and tracheotomy time in the death group were longer than those in the survival group （P〈C 0. 05）. Blood urea nitrogen levels of the death group were significantly higher than the survival group （P〈C0. 05）. Serum albu-min levels in the death group were significantly lower than those in the survival group （P〈C〇. 05）. Unconditional logistic re-gression analysis showed that age, mechanical ventilation time, low albumin level,and tracheotomy were the risk factors for death in patients with long-term mechanical ventilation. Conclusion Age, mechanical ventilation time, tracheotomy time, low albumin level,complications, high blood urea nitrogen are risk factors of death in patients with medium and long term me-chanical ventilation in intensive care unit. Clinicians should pay high attention to these risk factors and pay attention to preven-tion and treatment for reducing body damage, promoting the success rate of mechanical ventilation. Finally, it can reduce the mortality rate.