老年慢性阻塞性肺疾病急性加重患者有创机械通气撤机失败危险因素分析

Risk Factors Associated with Failure of Weaning from Invasive Mechanical Ventilation in Gerontal Patients with Acute Exacerbation of COPD

目的探讨进行有创机械通气的老年慢性阻塞性肺疾病(简称慢阻肺)急性加重患者撤机失败的危险因素。方法采用回顾性研究,选取2012年7月至2014年6月行有创机械通气治疗并符合撤机条件的76例65岁及以上慢阻肺急性加重患者。患者进行自主呼吸试验(SBT),通过后观察48 h,无需重新行机械通气者纳入撤机成功组,不能通过SBT或通过SBT后48 h内需重新行机械通气者纳入撤机失败组,分析撤机失败的危险因素。结果 53例患者纳入撤机成功组,23例纳入撤机失败组。撤机失败组脓毒症、多器官功能障碍综合征(MODS)、真菌感染、低蛋白血症、机械通气时间>14 d、气胸、心力衰竭、糖尿病、冠心病和肝功能不全发生率高于撤机成功组(P<0.05)。Logistic回归分析结果显示MODS(OR=8.070)、机械通气时间>14 d(OR=17.760)、心力衰竭(OR=4.597)、糖尿病(OR=13.937)是撤机失败的危险因素(P<0.05)。结论 MODS、机械通气时间>14 d、心力衰竭、糖尿病是老年慢阻肺急性加重患者有创机械通气撤机失败的危险因素。

Objective To investigate the risk factors associated with failure of weaning from invasive mechanical ventilation in gerontal patients with acute exacerbation of chronic obstructive pulmonary disease( AECOPD). Methods A retrospective study was conducted on 76 patients aged 65 years and older with AECOPD who received invasive mechanical ventilation and met the weaning criteria from July 2012 to June 2014. The subjects who passed the spontaneously breathing trial( SBT) and did not need mechanical ventilation within 48 h were enrolled into a weaning success group. The subjects who did not pass the SBT or needed mechanical ventilation again within 48 h were enrolled into a weaning failure group. The risk factors associated with failure of weaning were studied by univariate and multivariate Logistic regression analysis.Results There were 53 subjects in the weaning success group and 23 in the weaning failure group. The incidences of sepsis,multiple organ dysfunction syndrome( MODS),fungal infection,hypoproteinemia,duration for mechanical ventilation > 14 d,the prevalences of aeropleura,cardiac failure,diabetes,coronary heart disease and hepatic insufficiency were higher in the weaning failure group than those in the weaning success group( P < 0. 05). Logistic analysis revealed that MODS( OR = 8. 070),duration for mechanical ventilation > 14 d( OR = 17. 760),cardiac failure( OR = 4. 597) and diabetes( OR = 13. 937) were risk factors of weaning failure( P < 0. 05). Conclusion MODS,duration for mechanical ventilation > 14 d,cardiac failure and diabetes were associated with the failure of weaning from invasive mechanical ventilation in gerontal patients with AECOPD.