机械通气治疗急性脑血管病死亡的危险因素分析

Risk factors of death from mechanical ventilation in patients with acute cerebrovascular disease

目的探讨机械通气治疗急性脑血管病死亡的危险因素,为提升急性脑血管病救治成功率提供指导。方法回顾性分析我院急诊内科2014年1月至2017年6月行机械通气的急性脑血管疾病患者146例临床资料,按照预后状况分为生存组129例及死亡组17例,收集患者性别、年龄、体质量指数(BMI)、高血压病史、糖尿病史、吸烟史、抗血小板药物应用史、生化指标、肺部感染、急性生理与慢性健康评分(APACHEⅡ评分)、格拉斯哥昏迷评分(GCS)评分、尿量(24h)、机械通气方式、机械通气时间等资料,单因素及Logistic回归分析机械通气治疗急性脑血管病死亡的危险性因素。结果单因素分析显示年龄、高血压史、糖尿病史、血肌酐(Scr)、血尿素氮(BUN)、白细胞计数(WBC)、高敏-C反应蛋白(hs-CRP)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原(FDP)、D-二聚体(D-D)、肺部感染、APACHEⅡ评分、GCS评分、尿量(24h)、机械通气方式及机械通气时间是急性脑血管病机械通气预后的影响因素(P<0.05);Logistic回归分析显示、糖尿病史、空腹血糖(FPG)、BUN、Scr、GCS、肺部感染是急性脑血管疾病机械通气预后的影响因素(P<0.05)。结论年龄、糖尿病史、FPG、BUN、Scr、GCS、肺部感染是急性脑血管疾病机械通气独立预后影响因素,救治过程中应加强对上述指标的监测,积极纠正,提升患者生存率。

Objective To explore the risk factors of death from acute cerebrovascular disease by mechanical ventilation and provide guidance for improving the success rate of treatment of acute cerebrovascular disease.Methods The clinical data of 146 patients with acute cerebrovascular disease who underwent mechanical ventilation from January 2014 to June 2017 from our hospital were retrospectively analyzed.According to the prognosis,they were divided into survival group（n=129）and death group（n=17）.The patients′gender,age,BMI,history of hypertension,history of diabetes,smoking history,history of antiplatelet drug use,biochemical,pulmonary infection,APACHE Ⅱ score,GCS score,24 hurine volume,mechanical ventilation,mechanical ventilation time and other data were collected.Single factor and Logistic regression analysis analyzed the risk factors of mechanical ventilation in the treatment of acute cerebrovascular disease.Results Univariate analysis showed that age,history of hypertension,history of diabetes,Scr,BUN,WBC,hs-CRP,APTT,FDP,D-D,pulmonary infection,APACHE Ⅱ score,GCS score,24 urine volume,mechanical ventilation and mechanical ventilation time were the influencing factors of mechanical ventilation prognosis of acute cerebrovascular disease（P〈0.05）.Logistic regression analysis showed that age history of diabetes,FPG,BUN,GCS and pulmonary infection were the influencing factors of mechanical ventilation prognosis of acute cerebrovascular disease（P〈0.05）.Conclusion Age,history of diabetes,FPG,BUN,GCS,pulmonary infection are the independent prognostic factors of mechanical ventilation in patients with acute cerebrovascular disease.During the treatment,the above indicators should be monitored and corrected positively.