老年慢性阻塞性肺疾病急性加重患者机械通气撤机失败情况及其影响因素研究

Incidence and Influencing Factors of Ventilator Weaning Failure in Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

背景机械通气撤机失败会严重影响老年慢性阻塞性肺疾病急性加重(AECOPD)患者康复进程,因此探讨其影响因素具有重要临床意义。目的探讨老年AECOPD患者机械通气撤机失败情况及其影响因素。方法选取2015年5月-2018年4月武警陕西省总队医院收治的老年AECOPD患者165例,根据机械通气撤机情况分为A组(撤机成功,n=123)和B组(撤机失败,n=42)。比较两组患者一般资料〔包括性别、年龄、自主呼吸试验(SBT)结果、吸烟时间、居住地、镇静剂及糖皮质激素使用情况、分泌物引流量、累计机械通气时间〕及机械通气后心率(HR)、呼吸频率(RR)、收缩压(SBP)、舒张压(DBP)、动脉血气分析指标〔包括pH值、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)〕、肺动态顺应性、实验室检查指标〔包括白细胞计数(WBC)、C反应蛋白(CRP)、白介素6(IL-6)〕;老年AECOPD患者机械通气撤机失败的影响因素分析采用多因素Logistic回归分析。结果(1)两组患者性别、年龄、SBT结果及糖皮质激素使用情况比较,差异无统计学意义(P>0.05);B组患者吸烟时间>10年、城镇居住、使用镇静剂、分泌物引流量>200 ml、累计机械通气时间>7 d者所占比例高于A组(P<0.05)。(2)机械通气后,两组患者HR、RR、SBP、DBP、pH值、PaCO2、PaO2比较,差异无统计学意义(P>0.05);B组患者SaO2、肺动态顺应性低于A组,WBC、CRP、IL-6高于A组(P<0.05)。(3)多因素Logistic回归分析结果显示,吸烟时间〔OR=4.080,95%CI(1.675,9.935)〕、累计机械通气时间〔OR=3.662,95%CI(1.519,8.825)〕、肺动态顺应性〔OR=4.280,95%CI(1.425,12.857)〕、WBC〔OR=3.028,95%CI(1.234,7.429)〕是老年AECOPD患者机械通气撤机失败的独立危险因素(P<0.05)。结论老年AECOPD患者机械通气撤机失败发生率为25.5%,吸烟时间长、累计机械通气时间长、肺动态顺应性降低、WBC升高是老年AECOPD患者机械通气撤机失败的影响因素。

Background Ventilator weaning failure may seriously affect the rehabilitation in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),thus it is with important clinical significance to investigate the influencing factors.Objective To investigate the incidence and influencing factors of ventilator weaning failure in elderly patients with AECOPD.Methods A total of 165 elderly patients with AECOPD were selected in Shaanxi Provincial Armed Police Corps Hospital from May 2015 to April 2018,and they were divided into A group(with successful ventilator weaning,n=123)and B group(with failed ventilator weaning,n=42)according to the status of ventilator weaning.General information〔including gender,age,spontaneous breathing test(SBT)results,smoking time,place of residence,usage of sedatives and glucocorticoids,drainage volume of secretion and cumulative mechanical ventilation time〕,HR,RR,SBP,DBP,arterial blood gus analysis result(including pH value,PaCO2,PaO2,SaO2),pulmonary dynamic compliance,laboratory examination results(including WBC,CRP and IL-6)after mechanical ventilation were compared between the two groups;multivariate Logistic regression analysis was used to analyze the influencing factors of ventilator weaning failure in elderly patients with AECOPD.Results(1)There was no statistically significant difference in gender,age,SBT result or usage glucocorticoids between the two groups(P>0.05);proportion of patients with smoking time over 10 years,living in cities and towns,using sedatives,with drainage volume of secretion over 200 ml and cumulative mechanical ventilation time over 7 days in B group were statistically significantly higher than those in A group(P<0.05).(2)There was no statistically significant difference in HR,RR,SBP,DBP,pH value,PaCO2 or PaO2 between the two groups after mechanical ventilation(P>0.05);SaO2 and pulmonary dynamic compliance in B group were statistically significantly lower than those in A group,while WBC,CRP and IL-6 in B group were statistically significantly higher than those in A group(P<0.05).(3)Multivariate Logistic regression analysis results showed that,smoking time〔OR=4.080,95%CI(1.675,9.935)〕,cumulative mechanical ventilation time〔OR=3.662,95%CI(1.519,8.825)〕,pulmonary dynamic compliance〔OR=4.280,95%CI(1.425,12.857)〕and WBC〔OR=3.028,95%CI(1.234,7.429)〕were influencing factors of ventilator weaning failure in elderly patients with AECOPD(P<0.05).Conclusion Incidence of ventilator weaning failure was 25.5% in elderly patients with AECOPD,long smoking time,long cumulative mechanical ventilation time,low pulmonary dynamic compliance and high WBC are the influencing factors ventilator weaning failure.