NICU大面积脑梗死机械通气患者不同脱机方案的临床疗效及影响因素分析

Clinical efficacy and influencing factors of different methods of weaning from mechanical ventilation for patients with large hemispheric infarction(LHI)in NICU

目的比较程序化持续气道内正压(CPAP)脱机和经验性脱机应用于神经重症监护室(NICU)大面积脑梗死(LHI)行有创机械通气(IMV)患者的临床疗效,并分析LHI行IMV的患者成功脱机的相关影响因素。方法采用前瞻性随机对照临床研究方法,选择2018年4月—2019年6月在安徽医科大学附属宿州医院NICU收治的LHI行IMV的患者78例,根据随机数字表分组法原则分为CPAP组及经验组,每组39例。对两组患者的一般临床资料及IMV时间、脱机时间、呼吸机相关性肺炎(VAP)发生率、住院病死率、脱机成功率和NICU住院时间进行统计分析,比较两组脱机方式的临床疗效。采用单因素分析和多因素Logistic回归分析确定LHI行IMV患者成功脱机的影响因素。结果CPAP组患者的IMV时间、脱机时间、VAP发生率和NICU住院时间均低于经验组患者,差异有统计学意义(P<0.05)。两组患者的住院病死率和脱机成功率比较,差异无统计学意义(P>0.05)。LHI行IMV患者成功脱机影响因素单因素分析中年龄、IMV时间、脱机时间、血清白蛋白(ALB)、入室时APACHEⅡ评分、BNP和GCS评分之间的差异有统计学意义(P<0.05)。年龄、IMV时间、APACHEⅡ评分及GCS评分是NICU大面积脑梗死机械通气患者成功脱机的影响因素(P<0.05)。结论对于NICU大面积脑梗死行IMV患者而言,CPAP脱机在降低脱机时间、IMV时间、VAP发生率及NICU住院时间方面优于经验性脱机。年龄、IMV时间、APACHEⅡ评分及GCS评分是NICU大面积脑梗死机械通气患者成功脱机的影响因素。

Objective To compare the clinical efficacy of programmed continuous positive airway pressure(CPAP)weaning with conventional weaning from invasive mechanical ventilation(IMV)for patients with large hemispheric infarction(LHI)in neurological Intensive Care Unit(NICU),and the analysis of influencing factors related to successfully weaning from IMV for patients with LHI.Methods A clinical prospective randomized control study was conducted in this study.Seventy-eight patients with LHI undergone IMV at NICU of Suzhou Hospital Affiliated to Anhui Medical University from April 2018 to June 2019 were selected.According to random number table grouping principle,the patients were divided into a CPAP group(n=39)and an experience group(n=39).The clinical baseline data,IMV time,weaning time,incidence of ventilator-associated pneumonia(VAP),hospital mortality rate,successful rate of weaning and NICU hospitalization time in the two groups were statistically analyzed,the clinical efficacy of the two weaning methods were compared.Single factor analysis and multi-factor regression were used to confirm the influencing factors to successfully weaning from IMV in patients with LHI.Results Patients in the CPAP group had shorter IMV time,shorter weaning time,lower incidence of VAP and shorter NICU hospitalization time than the experience group,there were statistically significant differences(P<0.05).Comparison of hospital mortality rate and successful rate of weaning from ventilator between patients of the two groups showed no statistically significant differences(P>0.05).The single factor analysis of influencing factors to successfully weaning from ventilator in patients with LHI undergone IMV showed that the differences of age,IMV time,weaning time,serum albumin(ALB),APACHEⅡat NICU entry,BNP,and GCS scores were statistically significant(P<0.05).Age,IMV time,APACHEⅡscores and GCS scores were influencing factors of successfully weaning from IMV in patients with LHI in NICU(P<0.05).Conclusion As for patients with large hemispheric infarction undergone IMV in NICU,CPAP weaning is significantly superior to the experience weaning in reduction of the weaning time,IMV duration,the incidence rate of VAP and the NICU hospitalization time.The age,IMV time,APACHEⅡscores and GCS scores were influencing factors of successfully weaning from IMV in patients with LHI in NICU.