慢性阻塞性肺疾病机械通气患者支气管扩张试验影响因素分析

Analysis of influential factors in bronchodilation test in mechanically ventilated patients with chronic obstructive pulmonary diseases

目的探讨慢性阻塞性肺疾病(COPD)机械通气患者支气管扩张试验结果阳性的主要影响因素。方法收集2015年6月至2016年3月接受有创通气的COPD急性加重期(AECOPD)住院患者55例,应用支气管扩张剂前后分别进行准确的呼吸力学监测,以应用支气管扩张剂后气道阻力下降率超过12%为评判标准。将患者分为支气管扩张试验阳性组和阴性组,对比分析其影响因素,并进行统计学分析。结果 29例(52.7%)患者呈现阳性反应,26例(47.2%)患者阴性。单因素分析后,选取两组患者心率、动脉血氧饱和度(SaO_2)、真菌感染、激素治疗、肌酸激酶同工酶、乳酸、B型尿钠肽(P<0.1);将结果纳入多因素Logistic回归分析,发现真菌感染为影响支气管扩张试验结果的独立因素(P<0.05)。结论真菌感染是接受有创通气的COPD患者支气管扩张试验结果阳性的独立影响因素。

Objective To explore the main influential factors of bronchodilation test positive results in mechanically ventilated patients with chronic obstructive pulmonary disease(COPD).Methods A total of 55 inpatients with acute exacerbation of COPD(AECOPD)receiving the invasive ventilation from June 2015 to March 2016 were collected.The accurate respiratory mechanics monitoring was performed before and after using the bronchodilator.The airway resistance reduction over 12%after inhaling bronchodilator served as the judgment criteria,the patients were divided into the bronchodilation test positive or negative groups,then the influential factors were compared and statistical analysis was performed.Results Twenty-nine cases(52.7%)showed the positive reaction and 26 cases(47.2%)were negative.After univariate analysis,results of heart rate,SaO 2,fungal infection,hormonotherapy,CKMB,lactic acid and BNP were brought into the multivariable Logistic regression analysis(P<0.1).The analysis found that fungal infection was an independent factor affecting the results of the bronchodilation test(P<0.05).Conclusion Fungal infection is an independent influential factor of the bronchodilation test positive in COPD patients receiving invasive ventilation.