慢性阻塞性肺疾病急性加重期各项影响因素与伴发轻度认知功能障碍的影响因素分析

摘要

Objective It is to explore the correlation among the potential impact factors of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with mild cognitive impairment(MCI).Methods The patients with AECOPD were admitted from respiratory intensive care unit in our College Affiliated Hospital between May/1 st/2014 to January/1 st/2016 and from ICU in Jingzhou Central Hospital between January/1st/2015 to January/1st/2016.The patients were divided into MCI group and normal cognitive function (NCF) group according whether they had MCI.The information of all the patients such as gender,age,education,ethnicity,personal history,body mass index,past history,incidence of the consolidation,laboratory tests,clinical scores,mechanical ventilation(MV) related cases,special treatment were recorded and compared.The indexes with significant difference were selected as in dependent variable,AECOPD patient in complete remission of symptoms,or remission associated with MCI substantially within a week as the dependent variable,the independent effect factors of AECOPD with MCI were studied through the multivariate Logistic regression analysis.Results After inclusion and exclusion criteria,82 cases of AECOPD patients were ultimately included,in which 22 patients with MCI,60 patients with normal cognitive function.There were significant differences in APACHE Ⅱ scores,CAPS scores,p(O2)/Fi(O2),PCT,S-100,NSE,the cumulative duration of mechanical ventilation,education level,smoked age,pulmonary encephalopathy,broncho alveolar lavage,heparin spray treatment,MV strategy and MV weaning failure between the two groups (P ＜ 0.05).The results of multivariate Logistic regression analysis showed that Wherein the degree structure,broncho alveolar lavage,heparin nebulization were independent protective factors,APACHE Ⅱ scores,NSE,the cumulative duration of mechanical ventilation,smoked age,MV weaning failure were independent risk factors.Conclusion APACHE Ⅱ scores,NSE,the cumulative duration of mechanical ventilation,smoked age,MV weaning failure were risk factors of AECOPD with MCI,clinicians should be fully vigilant and give relevant timely screening,thereby leading to early detection,early intervention,effectively prevention of occurrence of MCI,improvement of clinical outcomes in patients with AECOPD.%目的 探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者各项潜在影响因素与伴发轻度认知功能损害(MCI)的影响因素.方法 纳入2014年5月1日-2016年1月1日湖北中医药高等专科学校附属医院呼吸内科监护室及2015年1月1日-2016年1月1日荆州市中心医院ICU病房收治的AECOPD患者为研究对象,根据是否伴发MCI将入选者分为伴发MCI组和认知功能正常组.统计所纳入患者的性别、年龄、文化程度、民族、个人史、体质量指数、既往史、伴发疾病情况、各项实验室检查、各项临床评分、机械通气相关情况、特殊治疗方式等资料并进行比较,选择差异有统计学意义的指标作为自变量,以AECOPD患者是否于症状完全缓解或基本缓解后1周内伴发MCI为因变量,多因素Logistic回归分析研究AECOPD伴发MCI的独立影响因素.结果 共纳入符合条件的AECOPD患者82例,其中伴发MCI组22例,认知功能正常组60例.2组APACHEⅡ评分、CAPS评分、p(O2)/Fi(O2)、p(CO2)、PCT、S-100、NSE、累计机械通气时间、学历构成、烟龄、合并肺性脑病、支气管肺泡灌洗、肝素雾化治疗、机械通气原则为有创-无创-撤机、机械通气撤机失败情况比较差异均有统计学意义(P均＜0.05).多因素Logistics回归分析显示,学历构成、支气管肺泡灌洗、肝素雾化治疗为独立保护因素,APACHEⅡ评分、NSE、累计机械通气时间、烟龄、机械通气撤机失败为独立危险因素.结论 APACHEⅡ评分、NSE、累计机械通气时间、烟龄、机械通气撤机失败是AECOPD发生MCI的危险因素,临床医生应予以充分警惕并及时进行相关筛查,从而做到尽早发现、尽早干预,有效避免MCI的发生,改善AECOPD患者的临床预后.