新型冠状病毒肺炎危重型患者拔除气管插管的影响因素

Study on influencing factors of extubation failure in critically ill patients with COVID-19

目的研究影响新型冠状病毒肺炎(COVID-19)危重型患者拔除气管插管成功的相关因素。方法回顾性分析收治的69例因COVID-19需行气管插管有创机械通气的危重型患者,根据患者拔管是否成功分为两组,比较两组患者基本临床资料、气管插管时相关实验室检查动态变化,并利用单因素和多因素logistic分析影响拔除气管插管的因素。结果69例COVID-19患者中,有46例(66.7%)拔管失败。拔管失败患者插管当天血清乳酸脱氢酶(LDH)和D-二聚体明显高于拔管成功患者(P<0.05)。住院期间,拔管失败组患者血小板计数和血红蛋白明显下降(P<0.05)。单因素logistic回归分析发现插管当天LDH>400 U/L、D-二聚体>4 g/L,住院期间血小板和肌红蛋白水平恶化是拔管失败的预后因素。多因素回归分析显示血小板水平下降是拔管失败的独立预后因素(OR=6.05,P=0.012)。结论血小板减少可能是影响COVID-19危重患者拔管结局的重要因素。LDH>400 U/L和D-二聚体>4 g/L可以帮助临床医生早期预测拔管失败的患者。此外,住院期间患者发生血小板减少或肌红蛋白水平升高可以用来预测拔管的结局。

Objective To address the influencing factors of extubation outcome in critically ill patients with COVID-19.Methods A retrospective study including 69 critically ill patients with COVID-19 requiring invasive mechanical ventilation.Clinical characteristics and dynamic laboratory findings were compared between the patients with extubation success and failure.Univariable and multivariable logistic regression methods were used to explore the risk factors for extubation failure.Results Extubation failure occurred in 46(66.7%)patients with COVID-19.The serum LDH and D-dimer were significantly higher in the patients with extubation failure than success on the day of intubation.During hospitalization,the platelet count and hemoglobin were markedly reduced in extubation failure.Univariable logistic regression found that LDH>400 U/L and d-dimer>4 g/L on the day of intubation,and deteriorated levels of platelet,hemoglobin and myoglobin during hospitalization were risk factors for extubation failure.Multivariable regression showed that the decrease of platelet count(odds ratio=6.05,P=0.012)was associated with extubation failure during hospitalization.Conclusion Thrombocytopenia may be an important factor affecting the extubation outcome in critically ill patients with COVID-19.The potential risk factors of LDH>400 U/L and d-dimer>4 g/L could help clinicians to identify patients with low extubation success rate at the early stage.Moreover,the patients who developed thrombocytopenia or elevated myoglobin during their hospitalization could serve to predict extubation outcome.