AECOPD伴呼吸衰竭患者短期内撤机拔管的影响因素分析

Analysis of Influencing Factors of Ablation of AECOPD Patients with Respiratory Failure in Short-term

目的研究慢性阻塞性肺疾病急性加重期伴呼吸衰竭患者短期内撤机拔管的影响因素。方法回顾性分析AECOPD伴呼吸衰竭并经有创机械通气治疗成功撤机拔管的患者总共34例。入选患者根据有创机械通气的时间分为两组,即通气时间≤3 d组及通气时间>3 d组。分别记录两组患者的性别、年龄、入科时的病程、APACHEⅡ评分、白蛋白、血红蛋白、红细胞分布宽度、C反应蛋白、降钙素原、乳酸等指标。将所有的指标进行单因素分析和多因素Logistic回归分析。结果两组患者之间的性别、年龄、病程及APACHEⅡ评分比较,差异均无统计学意义(P>0.05)。而通气时间≤3 d组患者血清白蛋白<30 g/L、血红蛋白<130g/L患者数均少于通气时间>3 d组,差异均有统计学意义(P<0.05)。两组患者入科时红细胞分布宽度、C反应蛋白、降钙素原水平比较,差异无统计学意义(P>0.05)。通气时间≤3 d组患者血乳酸>2 mmol/L患者数少于通气时间>3 d组,差异有统计学意义(P<0.05)。多因素Logistic回归分析示入科时血乳酸水平是慢性阻塞性肺疾病急性加重期患者有创机械通气时间>3 d独立的危险因素(P<0.05)。结论白蛋白、血红蛋白、乳酸均是AECOPD伴呼吸衰竭患者短期内撤机拔管的影响因素,其中患者入科时的血乳酸水平是慢性阻塞性肺疾病急性加重期患者有创机械通气时间>3 d独立的危险因素,积极干预处理影响因素,对患者尽早撤机拔管有重要意义。

Objective To study the influencing factors of short-term extubation and extubation in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure.Methods A total of 34 patients with AECOPD with respiratory failure and successful intubation with invasive mechanical ventilation were retrospectively analyzed. The enrolled patients were divided into two groups according to the time of invasive mechanical ventilation, that is, the ventilation time ≤ 3 d group and the ventilation time > 3 d group. The gender, age, duration of illness,APACHE II score, albumin, hemoglobin, red blood cell distribution width, C-reactive protein, procalcitonin, lactic acid and other indicators were recorded. All indicators were analyzed by univariate analysis and multivariate logistic regression analysis. Results There were no significant differences in gender, age, duration of disease and APACHE II score between the two groups(P>0.05).However, the number of patients with serum albumin < 30 g/L and hemoglobin < 130 g/L in ventilation time ≤ 3 d group was less than that in ventilation time > 3 d group,the differences were statistically significant(P<0.05). There was no significant difference in the distribution of red blood cells, C-reactive protein and procalcitonin levels between the two groups(P>0.05). The number of patients with blood lactic acid >2 mmol/L in the ventilatory time ≤3 d group was less than that in the ventilation group >3 d group, the difference was statistically significant(P<0.05). Multivariate logistic regression analysis showed that blood lactate level was a risk factor for invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease >3 d(P<0.05).Conclusion Albumin, hemoglobin and lactic acid are the influencing factors of AECOPD patients with respiratory failure in the short-term withdrawal. The blood lactate level of patients with acute obstructive pulmonary disease is the invasive mechanical ventilation time of patients with acute exacerbation of chronic obstructive pulmonary disease >3 d Independent risk factors, active intervention to deal with the influencing factors, the importance of early withdrawal and extubation of patients.