序贯机械通气治疗老年慢性阻塞性肺疾病急性加重患者死亡的相关因素分析

Death-Related Factors in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease Treated by Sequential Mechanical Ventilation

目的分析序贯机械通气治疗老年慢性阻塞性肺疾病急性加重(AECOPD)患者死亡的相关因素,为临床提供参考。方法回顾性分析2015年6月至2021年6月收治的采用序贯机械通气治疗的1204例老年(≥60岁)AECOPD患者的临床资料,统计患者死亡率,分析死亡影响因素。结果1204例序贯机械通气治疗老年AECOPD患者中,167例(13.87%)死亡;多因素分析提示,血浆降钙素原≥0.5μg/L(OR=2.762,95%CI=1.920~3.972,P<0.001)、每天有创通气时间≥12 h(OR=2.202,95%CI=1.487~3.262,P<0.001)、多重耐药菌感染(OR=1.790,95%CI=1.237~2.591,P=0.002)、氧合指数<39.90 kPa(OR=2.447,95%CI=1.625~3.685,P<0.001)、糖化血红蛋白>6%(OR=2.288,95%CI=1.509~3.470,P<0.001)、急性生理学与慢性健康状况评分Ⅱ评分≥25分(OR=2.126,95%CI=1.432~3.156,P<0.001)6个因素为序贯机械通气治疗AECOPD患者死亡的独立危险因素;口腔护理>2次/d(OR=0.676,95%CI=0.457~1.000,P=0.048)与排痰次数>2次/d(OR=0.492,95%CI=0.311~0.776,P=0.002)是序贯机械通气治疗老年AECOPD患者死亡的独立保护因素。结论序贯机械通气治疗老年AECOPD患者死亡与多种因素有关。重点关注重症患者、提高氧气流量、恢复氧合功能、减少不必要有创通气时间、控制血糖、防治多重耐药菌感染、每天做2次以上口腔护理、每天做2次以上排痰是减少序贯机械通气治疗老年AECOPD患者死亡率的有效措施。

Objective To analyze the death-related factors of elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)treated by sequential mechanical ventilation,so as to provide evidence for clinical practice.Methods The clinical data of 1204 elderly patients(≥60 years old)with AECOPD treated by sequential mechanical ventilation from June 2015 to June 2021 were retrospectively analyzed.The probability and influencing factors of death were analyzed.Results Among the 1204 elderly patients with AECOPD treated by sequential mechanical ventilation,167(13.87%)died.Multivariate analysis showed that plasma procalcitonin≥0.5μg/L(OR=2.762,95%CI=1.920-3.972,P<0.001),daily invasive ventilation time≥12 h(OR=2.202,95%CI=1.487-3.262,P<0.001),multi-drug resistant bacterial infection(OR=1.790,95%CI=1.237-2.591,P=0.002),oxygenation index<39.90 kPa(OR=2.447,95%CI=1.625-3.685,P<0.001),glycosylated hemoglobin>6%(OR=2.288,95%CI=1.509-3.470,P<0.001),and acute physiology and chronic health evaluationⅡscore≥25 points(OR=2.126,95%CI=1.432-3.156,P<0.001)were independent risk factors for death in patients with AECOPD treated by sequential mechanical ventilation.Oral care>twice/d(OR=0.676,95%CI=0.457-1.000,P=0.048)and sputum excretion>twice/d(OR=0.492,95%CI=0.311-0.776,P=0.002)were independent protective factors for death in elderly patients with AECOPD treated by sequential mechanical ventilation.Conclusions The outcomes of sequential mechanical ventilation in the treatment of elderly patients with AECOPD are affected by a variety of factors.To reduce the mortality,we put forward the following measures:attaching great importance to severe patients,restoring oxygenation function,shortening unnecessary invasive ventilation time,controlling blood glucose,preventing multidrug resistant bacterial infection,oral care twice a day,and sputum excretion twice a day.