影响呼吸重症监护病房慢性阻塞性肺病患者机械通气时间的因素

目的:探讨呼吸重症监护病房的慢性阻塞性肺病(COPD)患者机械通气时间分别大于7,14,21 d的潜在危险因素.方法:前瞻性记录和回顾性分析患者在疾病稳定期,入住呼吸重症监护病房时及在呼吸重症监护病房期间的特征.以t检验,X2检验和逻辑回归分析作为统计学方法.结果:63例COPD需要机械通气患者入选.其中26例患者机械...

Risk Factors in Relation to the Time of Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Diseases in Respiratory Intensive Care Unit

Objective: To determine the potential risk factors for mechanical ventilation (MV)over periods of 7,14, or 21 days respectively in patients with chronic obstructive pulmonary disease (COPD) in respiratory Intensive Care Unit(RICU). Methods: The characteristics of patients during the stable period of their disease, on admission to RICU and during the RICU stay, were recorded prospectively and analyzed retrospectively. The statistical analysis included t test, chi-square test and logistic regression analysis. Results: A total of 63 patients with COPD requiring MV were included in the study. Twenty-six cases and 41% of the patients required MV shorter than 7 days, 20(32%),8(13%) and 9(14%) of the patients required MV longer than 7, 14 and 21 days respectively. There were no significant relationships between the duration of MV and the presence of community-acquired pneumonia (CAP) on admission, baseline pulmonary function test results or blood gas parameters on admission. Development of ventilator-associated pneumonia (VAP; odds ratio, OR: 5.8; 95% CI: 2-22, P=0.013) were independent predictors for MV>7 days. VAP was still a risk factor for MV>14 days (OR: 15; 95% CI: 1-1.5,P=0.002). On the other hand MV>21 days was related with severity of the disease on admission measured by APACHE Ⅱ score (OR: 1.7; 95% CI: 1-1.5, P=0.002) and albumin levels (OR: 0.50; 95% CI: 0.27-0.61, P=0.006). Conclusion: Severity of disease on admission and development of VAP during RICU stay are the main determinants of MV duration in patients with COPD.