急性呼吸衰竭患者机械通气过程中血乳酸、血清白蛋白的变化及其对撤机结局的影响

Changes of blood lactic acid and serum albumin in patients with acute respiratory failure during mechanical ventilation and their effects on the outcome of withdrawal

目的:分析急性呼吸衰竭患者机械通气过程中血乳酸、血清白蛋白的变化及其对撤机结局的影响。方法:回顾性收集本院2020年6月-2022年5月期间接受机械通气治疗的106例急性呼吸衰竭患者的临床资料。并于撤机前完成血清白蛋白、血乳酸水平检测。根据撤机结局将患者分为撤机失败组和撤机成功组。设计基线资料收集表,将可能的影响因素纳入。经Logistic回归分析检验找出影响急性呼吸衰竭患者机械通气撤机结局的因素。结果:106例急性呼吸衰竭患者资料中撤机失败31例,占比29.25%。撤机失败组中长期吸烟史占比、血乳酸水平均显著高于撤机成功组,机械通气时间显著长于撤机成功组,血清白蛋白水平显著低于撤机成功组(P<0.05)。两组的年龄、性别、体重指数、动脉血氧分压、动脉二氧化碳分压进行比较,差异均无统计学意义(P>0.05)。经Logistic回归分析结果显示,长期吸烟史、机械通气时间长及血乳酸高表达是急性呼吸衰竭患者机械通气撤机结局的危险因素(OR>1,P<0.05),血清白蛋白高表达是其保护因素(OR<1,P<0.05)。结论:急性呼吸衰竭患者机械通气过程中血乳酸高表达、血清白蛋白低表达可增加撤机失败的风险,且长期吸烟史、机械通气时间与急性呼吸衰竭患者撤机结局有关。

Objective:To analyze the changes of blood lactic acid and serum albumin in patients with acute respiratory failure during mechanical ventilation and their effects on the outcome of withdrawal.Methods:The clinical data of 106 patients with acute respiratory failure who received mechanical ventilation from June 2020 to May 2022 were retrospectively collected.Serum albumin and blood lactic acid levels were measured before withdrawal.According to the outcome of withdrawal,the patients were divided into failure group and successful group.Design a baseline data collection table to incorporate possible influencing factors.Logistic regression analysis was performed to find out the factors affecting the outcome of mechanical ventilation in patients with acute respiratory failure.Results:In 106 patients with acute respiratory failure,31 cases(29.25%)failed to withdraw the machine.The long-term smoking history ratio and blood lactic acid level in the failed group were significantly higher than those in the successful group,the mechanical ventilation time was significantly longer than that in the successful group,and the serum albumin level was significantly lower than that in the successful group(P<0.05).There were no significant differences in age,sex,body mass index,arterial blood oxygen partial pressure and arterial carbon dioxide partial pressure between the two groups(P>0.05).Logistic regression analysis showed that long-term smoking history,long mechanical ventilation time and high expression of blood lactic acid were the risk factors for the outcome of mechanical ventilation in patients with acute respiratory failure(OR>1,P<0.05),and high serum albumin expression was the protective factor(OR<1,P<0.05).Conclusion:High expression of blood lactic acid and low expression of serum albumin can increase the risk of withdrawal failure in patients with acute respiratory failure during mechanical ventilation,and long-term smoking history and mechanical ventilation time are related to the outcome of patients with acute respiratory failure.