慢性阻塞性肺疾病并呼吸衰竭患者有创机械通气撤机失败的影响因素研究

摘要

目的 探讨慢性阻塞性肺疾病(COPD)并呼吸衰竭患者有创机械通气撤机失败的影响因素.方法 选择2015年在武汉大学人民医院重症医学科行机械通气治疗的COPD并呼吸衰竭患者168例,收集其临床资料并建立数据库,包括性别、年龄、浅快呼吸指数、改良的早期预警量表(MEWS)评分、临床肺部感染量表(CPIS)评分、血浆氨基末端脑钠肽前体(NT-proBNP)水平、便隐血试验阳性率、焦虑发生率、胃肠功能受损情况、血清清蛋白水平、机械通气时间等.结果 168例患者中撤机成功138例,撤机失败30例,撤机失败发生率为17.9％.撤机失败者浅快呼吸指数、MEWS评分、CPIS评分、血浆NT-proBNP水平及胃肠功能损伤发生率高于撤机成功者,血清清蛋白水平低于撤机成功者,机械通气时间长于撤机成功者(P＜0.05);而两组患者性别、年龄、便隐血试验阳性率、焦虑发生率比较,差异无统计学意义(P＞0.05).多因素Logistic回归分析结果显示,浅快呼吸指数[OR=2.776,95％CI(1.060,7.272)]、胃肠功能损伤[OR =2.784,95％CI (2.325,10.964)]是COPD并呼吸衰竭患者撤机失败的危险因素(P＜0.05).结论 浅快呼吸指数和胃肠功能损伤是COPD并呼吸衰竭患者有创机械通气撤机失败的危险因素.%Objective To investigate the influencing factors of ventilator weaning failure in COPD patients complicated with respiratory failure undergoing invasive mechanical ventilation.Methods In 2015,a total of 168 COPD patients complicated with respiratory failure undergoing invasive mechanical ventilation were selected in the Department of Intensive Medicine,the People's Hospital of Wuhan University,all of their clinical data was collected and relevant database was set up,including gender,age,rapid shallow breathing index,Modified Early Warning Scale (MEWS) score,Clinical Pulmonary Infection Scale (CPIS) score,plasma NT-proBNP level,positive rate of fecal occult blood test,incidence of anxiety disorder and gastrointestinal function damage,serum albumin level and duration of mechanical ventilation.Results The incidence of ventilator weaning failure was 17.9％ (30/168).Rapid shallow breathing index,MEWS score,CPIS score,plasma NT-proBNP level and incidence of gastrointestinal function damage of patients with ventilator weaning failure were statistically significantly higher than those of patients with successful ventilator weaning,serum albumin level of patients with ventilator weaning failure was statistically significantly lower than that of patients with successful ventilator weaning,duration of mechanical ventilation of patients with ventilator weaning failure was statistically significantly longer than that of patients with successful ventilator weaning (P ＜0.05),while no statistically significant differences of gender,age,positive rate of fecal occult blood test or incidence of anxiety disorder was found between patients with ventilator weaning failure and patients with successful ventilator weaning (P ＞0.05).Multivariate Logistic regression analysis results showed that,rapid shallow breathing index [OR =2.776,95％ CI (1.060,7.272)] and gastrointestinal function damage [OR =2.784,95％ CI (2.325,10.964)] were risk factors of ventilator weaning failure in COPD patients complicated with respiratory failure undergoing invasive mechanical ventilation (P ＜ 0.05).Conclusion Rapid shallow breathing index and gastrointestinal function damage are risk factors of ventilator weaning failure in COPD patients complicated with respiratory failure undergoing invasive mechanical ventilation.