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

发布时间：2018-01-23 02:26

本文关键词： 慢性阻塞性肺疾病机械通气撤机　出处：《中国呼吸与危重监护杂志》2015年01期 　论文类型：期刊论文

【摘要】：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(P0.05)。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(P0.05)。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。
[Abstract]:Objective to investigate the risk factors for the failure of weaning in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) undergoing invasive mechanical ventilation. From July 2012 to June 2014, 76 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) aged 65 years and above who were treated with invasive mechanical ventilation and who were in accordance with the condition of weaning were enrolled in this study. The patients were treated with autonomic respiratory test (SBT). After 48 hours of observation, the patients without mechanical ventilation were included in the successful group of weaning, and those who could not pass through SBT or 48 h after SBT were included in the failed group of weaning. Results 53 patients were included in the successful weaning group 23 patients were included in the failed weaning group sepsis multiple organ dysfunction syndrome mods infection. Hypoproteinemia, 14 days mechanical ventilation, pneumothorax, heart failure, diabetes. The incidence of coronary heart disease and liver dysfunction was higher than that of successful weaning group (P 0.05). Logistic regression analysis showed that MODS orr was 8.070). The mechanical ventilation time was 14 days and the duration of mechanical ventilation was 17.760.The heart failure was 4.597). Conclusion MODS, mechanical ventilation time 14 days, heart failure. Diabetes is a risk factor for failure of invasive mechanical ventilation in elderly patients with acute exacerbation of COPD.
【作者单位】：中山大学附属第五医院重症医学科;珠海市第二人民医院急危重症医学科;
【分类号】：R563.9
【正文快照】： (广东珠海519000)慢性阻塞性肺疾病(简称慢阻肺)是以气流受限为主要特征的慢性炎症性疾病[1]。其常见于老年人群,随着老龄化的进程,其发病率也呈增长趋势,慢阻肺已成为主要的致死和致残疾病之一[2]。老年慢阻肺患者常合并其他疾病从而加重患者身体机能的衰退[3]。呼吸衰竭是慢

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