脱机拔管后呼吸衰竭患者序贯经鼻高流量湿化氧疗失败的危险因素分析

Risk factors for failure of sequential high-flow nasal cannula oxygen therapy in patients with respiratory failure after weaning from invasive ventilation

目的分析拔管后仍存在呼吸衰竭的患者序贯经鼻高流量湿化氧疗(HFNC)失败率及其危险因素。方法回顾性分析2017年1月1日至2019年3月31日入住福建省立医院ICU气管插管拔管后行序贯HFNC的145例患者。根据HFNC成功与否将其分为HFNC成功组(113例)和HFNC失败组(32例)。比较两组患者的临床资料及实验室指标,并采用Logistic回归分析探究HFNC治疗失败的独立危险因素。结果HFNC成功组和HFNC失败组患者插管原因(χ^(2)=11.224,P=0.024)、慢性心力衰竭(χ^(2)=4.863,P=0.027)、心脏瓣膜病(χ^(2)=6.435,P=0.011)、呼吸道病原学阳性(χ^(2)=8.909,P=0.003),拔管当天序贯器官衰竭估计评分(Z=2.138,P=0.032)、急性病生理学和长期健康评价Ⅱ评分(t=2.307,P=0.023),插管期间使用血管活性药物(χ^(2)=4.153,P=0.042)和雾化N-乙酰半胱氨酸(χ^(2)=4.531,P=0.033),拔管前2 d内中性粒细胞计数(t=2.170,P=0.032)、淋巴细胞总数<0.8×10^(9)/L(χ^(2)=5.941,P=0.024)、降钙素原(Z=2.656,P=0.008)比较,差异均有统计学意义。多因素Logistic回归分析结果显示,拔管前2 d内外周血淋巴细胞总数<0.8×10^(9)/L[比值比(OR)=2.898,95%置信区间(CI)(1.059,7.935),P=0.038]和呼吸道病原学阳性[OR=4.617,95%CI(1.463,14.568),P=0.009]为HFNC失败的独立危险因素。结论拔管前2 d内外周血淋巴细胞计数<0.8×10^(9)/L和呼吸道病原体阳性为气管插管拔管后仍存在呼吸衰竭的患者序贯HFNC失败的独立危险因素。

Objective To investigate the failure rate and risk factors of sequential high-flow nasal cannula oxygen therapy(HFNC)in patients still with respiratory failure after weaning from invasive ventilation.Methods Patients who accepted sequential HFNC after weaning from invasive ventilation in the ICU of Fujian Provincial Hospital from January 1st 2017 to March 31st 2019 were retrospectively analyzed.Patients were divided into the HFNC success group(113 cases)and HFNC failure group(32 cases)according to the success or failure of HFNC.The clinical data and laboratory indicators were compared between the two groups.Logistic regression was used to analyze the independent risk factors for HFNC treatment failure.Results The differences between the two groups were statistically significant in the following factors:the causes of intubation(χ^(2)=11.224,P=0.024),chronic heart failure(χ^(2)=4.863,P=0.027),valvular heart disease(χ^(2)=6.435,P=0.011),positive respiratory pathogens(χ^(2)=8.909,P=0.003),sequential organ failure assessment score(Z=2.138,P=0.032)and acute physiology and long-term health evaluationⅡscore(t=2.307,P=0.023)on the day of extubation,the use of vasoactive drugs(χ^(2)=4.153,P=0.042)and nebulized N-acetylcysteine(χ^(2)=4.531,P=0.033)during intubation,and neutrophil count(t=2.170,P=0.032),lymphocyte count<0.8×10^(9)/L(χ^(2)=5.941,P=0.024)and procalcitonin(Z=2.656,P=0.008)within 2 days before extubation.Multivariate Logistic regression analysis showed that the total number of peripheral blood lymphocytes<0.8×10^(9)/L within 2 days before extubation[odds ratio(OR)=2.898,95%confidence interval(CI)(1.059,7.935),P=0.038]and positive respiratory pathogens[OR=4.617,95%CI(1.463,14.568),P=0.009]were independent risk factors for HFNC failure.Conclusion The peripheral blood lymphocyte count<0.8×10^(9)/L within 2 days before extubation and positive respiratory pathogens are independent risk factors for sequential HFNC failure in patients with respiratory failure after extubation.