慢性阻塞性肺疾病患者机械通气时间的影响因素

目的 探讨影响慢性阻塞性肺疾病(COPD)患者机械通气(MV)时间的危险因素.方法 回顾性研究128例COPD合并呼吸衰竭患者插管前及通气过程中的临床指标.单凶素分析采用t检验、秩和检验及X2检验.将统计意义的变量导人多元逐步togis～e回归分析.结果 NV>7 d、14 d和21 d的患者比例分别为61%、20%和9%.MV>7 d、14 d和21 d的患者,分别与MV≤7 d、14 d和21 d的患者进行比较,在COPD病史、吸烟指数、肺功能和合并症等方面差异无统计学意义(P<0.05).多因素回归分析显示,APACHEⅡ评分是影响MV>7 d的独立危险因子(OR:2.3;95%CI:1.2～5.7,P=0.02);影响MV>21 d的危险因素是休克(OR:0.7;95%CI:1.0～1.9,P=0.04)和低白蛋白水平(OR:0.4,95%CI:0.2～0.8,P=0.003);机械通气相关性肺炎(VAP)是影响机械通气时间最重要的危险因素(P<0.05).结论 APACHEⅡ评分、血清白蛋白水平、发生休克或VAP是影响COPD患者机械通气时间的主要因素.

Influencing factor of mechanical ventilation time in patients with chronic obstructive pulmonary disease

Objective To study influencing factor of mechanical ventilation (MV) time in patients withchronic obstructive pulmonary disease (COPD). Method Totally 128 patients with COPD and respiratory failurerequiting ventilation support were retrespectively investigated. The clinical characteristics of patients before and af-ter intuhation during the respiratory intensive care unit (RICU) stay were recorded and analyzed, t- test, X2 testand stepwise logistic regression analysis were used for statistical analysis. Results In the 128 patients, 61%,20%, and 9% of the patients required MV longer than 7, 14 and 21 days, respectively. There were no significantdifferences in the history of COPD, smoking, lung function, and complications between patients with MV>7 d, 14d, 21 d and patients with MV<7 d, 14 d, 21 d. Multiple regression analysis showed APACHE Ⅱ score (OR:2.3; 95% Ca: 1.2-5.7, P = 0.02) was an independent factor for MV > 7 days, while shock (OR: 0.7;95% CI: 1.0-1.9, P = 0.04) and decreased serum albumin (OR: 0.4, 95% CI: 0.2-0.8, P = 0.003)were an independent factors for MV > 21 days. The ventilator-associated pneumonia (VAP) was the most impor-rant risk factor for the time of MV. Conclusions APACHE Ⅱ score, serum albumin levels, hock and VAP arethe main factors affecting MV time in patients with COPD.