慢性阻塞性肺疾病急性加重期患者有创-无创序贯通气首次撤机失败状况及其危险因素研究

Study on the first weaning failure of invasive/non-invasive sequential ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease and its risk factors

目的 探讨急诊重症监护室(EICU)慢性阻塞性肺疾病急性加重期(AECOPD)患者有创-无创序贯通气首次撤机失败状况及其危险因素。方法 回顾性分析2019年3月至2022年3月浙江省湖州市第一人民医院EICU收治的150例AECOPD患者的临床资料,患者均接受有创-无创序贯通气治疗,依据首次撤机是否成功将患者分为成功组(98例)和失败组(52例)。比较2组患者基线资料,采用多因素Logistic回归方法分析AECOPD患者有创-无创序贯通气首次撤机失败的危险因素。结果 AECOPD患者有创-无创序贯通气首次撤机失败组入EICU时急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、合并2种及以上基础性疾病比例、合并低蛋白血症比例、血清N末端B型脑钠肽前体(NT-proBNP)、降钙素原水平均高于成功组,差异均有统计学意义(均P<0.05);2组间其他基线资料比较,差异无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示,入EICU时APACHEⅡ评分高、合并基础性疾病种类2种及以上、合并低蛋白血症、拔管时血清NT-proBNP高、降钙素原高是AECOPD患者有创-无创序贯通气首次撤机失败的危险因素(比值比=1.135、3.807、3.888、1.023、17.646,95%置信区间:1.047~1.232、1.877~7.722、1.902~7.948、1.014~1.033、2.353~132.347,均P<0.05)。结论 AECOPD患者有创-无创序贯通气首次撤机失败危险因素可能为入EICU时APACHEⅡ评分高、合并基础性疾病种类2种及以上、合并低蛋白血症、血清NT-proBNP、降钙素原水平高。

Objective To explore the first weaning failure of invasive/non-invasive sequential ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in emergency intensive care unit(EICU)and its risk factors.Methods From March 2019 to March 2022,the clinical data of 150 patients with AECOPD admitted to EICU of the First People′s Hospital of Huzhou,Zhejiang Province were retrospectively analyzed.All patients received invasive/non-invasive sequential ventilation.Patients were divided into success group(98 cases)and failure group(52 cases)according to whether the first weaning was successful.The baseline data of the patients were compared between the two groups.Multivariate Logistic regression method was used to analyze the risk factors of the first weaning failure of invasive/non-invasive sequential ventilation in patients with AECOPD.Results For AECOPD patients with the first weaning of invasive/non-invasive sequential ventilation,the acute physiology and chronic health scoring systemⅡ(APACHEⅡ)score when the patients entered EICU,the proportion of two or more types of combined basic diseases,the proportion of combination of hypoproteinemia,the levels of serum N-terminal pro-brain natriuretic peptide(NT-proBNP)and procalcitonin in the failure group were higher than those in the success group(P<0.05),the comparisons of other baseline data between the two groups were not statistically different(P>0.05).When the patients entered EICU,multivariate Logistic regression analysis showed that high APACHEⅡscore,two or more types of combined basic diseases,the combination of hypoproteinemia,high levels of serum NT-proBNP and procalcitonin at extubation were the risk factors for the first weaning failure of invasive/non-invasive sequential ventilation in patients with AECOPD(odds ratio=1.135,3.807,3.888,1.023,17.646,95%confidence interval:1.047-1.232,1.877-7.722,1.902-7.948,1.014-1.033,2.353-132.347;all P<0.05).Conclusion Risk factors for the first weaning failure of invasive/non-invasive sequential ventilation in patients with AECOPD may be high APACHEⅡscore,combined with two or more types of basic diseases,the combination of hypoproteinemia,and high levels of serum NT-proBNP and procalcitonin when the patients entered EICU.