原发性脑出血并呼吸衰竭患者撤机拔管成功的影响因素

Influencing factors of successful extubation and withdrawal in patients with primary cerebral hemorrhage and respiratory failure

目的探讨原发性脑出血并呼吸衰竭患者撤机拔管成功的影响因素。方法选取2017年1月～2018年6月长沙市第四医院(以下简称"我院")治疗的原发性脑出血合并呼吸衰竭患者82例,均在我院接受有创机械通气治疗,根据撤机拔管是否成功将其分为成功组(n=63)和失败组(n=19)。比较两组患者临床资料差异;采用Logistic回归分析原发性脑出血并呼吸衰竭患者撤机拔管成功的影响因素。结果撤机拔管成功率为76.83%,失败率为23.17%;失败组患者年龄、出血量、慢性阻塞性肺疾病(COPD)病史和美国国立卫生院卒中量表(NIHSS)评分明显高于成功组(P <0.05),而格拉斯哥昏迷评分(GCS评分)、拔管时血白蛋白明显低于成功组(P <0.05);年龄、出血量、COPD病史以及拔管时血白蛋白是原发性脑出血合并呼吸衰竭患者撤机拔管成功的影响因素(OR=2.197、1.578、2.275、0.582,P <0.05)。结论原发性脑出血并呼吸衰竭患者撤机拔管成功的影响因素包括患者年龄、出血量、COPD病史以及拔管时血白蛋白水平,治疗过程中应考虑相关影响因素并进行及时干预。

Objective To investigate the influencing factors of successful extubation and withdrawal in patients with primary cerebral hemorrhage and respiratory failure.Methods From January 2017 to June 2018,82 patients with primary cerebral hemorrhage complicated with respiratory failure were selected from the Changsha Fourth Hospital("our hospital"for short).They were all treated with invasive mechanical ventilation in our hospital.They were divided into success group(n=63)and failure group(n=19)according to whether the extubation and withdrawl was sucessful.The clinical data of the two groups were compared.Logistic regression was used to analyze the influencing factors of successful extubation and withdrawal in patients with primary cerebral hemorrhage and respiratory failure.Results The successful rate of extubation and withdrawal was 76.83%and the failure rate was 23.17%.The age,bleeding volume,history of chronic obstructive pulmonary disease(COPD)and National Institute of Health Stroke scale(NIHSS)score of the failure group were significantly higher than those of the success group(P<0.05),while Glasgow Coma Scale score(GCS score)and serum albumin at extubation were significantly lower than those of the success group(P<0.05);age,bleeding volume,history of COPD,and serum albumin at the time of extubation were the influencing factors for successful extubation and withdrawal in patients with primary cerebral hemorrhage complicated with respiratory failure(OR=2.197,1.578,2.275,0.582,P<0.05).Conclusion The influencing factors of successful extubation and withdrawal in patients with primary cerebral hemorrhage and respiratory failure include age,amount of bleeding,COPD history and serum albumin level during extubation.The relevant influencing factors should be considered in the course of treatment and timely intervention.