长期机械通气老年患者撤机的影响因素分析

目的探讨长期机械通气的老年患者撤机的影响因素。方法回顾性分析2006年1月至2010年6月内科重症监护病房（MICU）收治的136例长期机械通气的老年患者。根据撤机成败判定标准将全部病例分为撤机成功组（72例）和撤机失败组（64例），比较两组患者机械通气时间、年龄、住院时间、气管切开例数、基础疾病和入科第1天及第10天的急性病生理学和长期健康评价（APACHE）Ⅲ评分及各项生理指标，采用logistic回归分析法对各指标进行分析，并运用受试者工作特征（ROC）曲线对第10天的APACHEm评分及血乳酸水平预测长期机械通气的老年患者撤机成功与否作评价。结果两组患者住院时间比较差异有统计学意义（P〈0．05），撤机成功组患者第1天仅APACHEⅢ评分、白蛋白水平优于撤机失败组（P均〈0．05）；第10天APACHEⅢ评分、氧合指数、平均动脉压、肺泡一动脉血氧分压差、血乳酸、白细胞、血小板、总胆红素、丙氨酸转氨酶、肌酐、白蛋白、血糖、血钠水平均优于撤机失败组（P均〈0．05）。logistic分析示第10天APACHEm评分〉60分、第10天血乳酸〉2．0mmol／L是影响撤机成功与否的独立危险因素，其ROC曲线下面积分别为0．894（95％可信区间：0．836～0．951）、0．738（95％可信区间：0．648～0．828）。结论APACHEm评分、血乳酸水平对预测长期机械通气患者能否成功撤机有一定影响。

Influencing factors analysis on ventilator weaning in the aged undergoing long-term mechanical ventilation

Objective To explore the influencing factors of ventilator weaning outcomes in the aged undergoing long-term mechanical ventilation.Methods A retrospective analysis was performed in 136 patients aged over 60 undergoing long-term mechanical ventilation in medical intensive care unit(MICU) from January 2006 to June 2010.All the patients were divided into success group(72 cases) and failure group(64 cases) according to weaning outcomes.The mechanical ventilation duration,age,MICU length of stay,tracheostomy cases,primary diseases,physiological indicators and acute physiology and chronic health evaluation(APACHE) Ⅲ score on the 1st and 10th d were recorded and compared.T test,varianceest,rank sun test and logistic regression model were used for statistical analysis.The receiver operating characteristic(ROC) curve was drawn to evaluate the value of APACHE Ⅲ score and blood lactate level on 10th d in predicting ventilator weaning outcomes in the aged undergoing long-term mechanical ventilation.Results There was statistical significance in MICU length of stay between the two groups(P < 0.05).In the success group,the APACHE Ⅲ score and the level of albumin were better than the failure group on 1st d(all P < 0.05).However,the APACHE Ⅲ score,oxygen index,mean arterial pressure,alveolar-arterial oxygen tension difference,blood lactate,white blood cell,platelet,total bilirubin,alanine aminotransferase,creatinine,albumin,glucose and natremia all showed significant differences on 10th d between the two groups(all P < 0.05).The APACHE Ⅲ score > 60 and the blood lactate > 2.0 mmol /L on 10th d were independent influencing factors for predicting ventilator weaning outcomes,and the area under the ROC curve of those factors were 0.894 [95% confidence interval(95% CI):0.836-0.951] and 0.738(95% CI:0.648-0.828),respectively.Conclusion The APACHE Ⅲ score and the level of blood lactate can effect weaning outcomes in the aged undergoing long-term mechanical ventilation.