急性低氧性呼吸衰竭患者气管插管后低血压风险的多因素分析与预后研究

目的研究急性低氧性呼吸衰竭患者气管插管后低血压发生危险因素及预后,为进一步治疗提供依据.方法回顾分析2016年1月至2019年3月徐州医科大学附属医院急诊重症医学科收治的110例急性低氧性呼吸衰竭气管插管患者的临床资料.根据气管插管后血压情况分成两组:低血压组(n=35)和非低血压组(n=75).比较两组患者一般资料、气管插管前生命体征、休克指数(SI)、气管插管时不同诱导药物等指标,采用Logistic多元回归模型、受试者工作特征(ROC)生存曲线预测气管插管后低血压的风险因素及28 d病死率.结果两组患者插管前收缩压、SI、使用肌松药、合并慢性阻塞性肺疾病(COPD)或慢性肾功能不全差异有统计学意义(P<0.05),而年龄、性别、其他慢性疾病、插管前使用肌松药以外药物、急性生理学与慢性健康状况评估系统Ⅱ(APACHEⅡ)评分等指标差异无统计学意义(P>0.05).多因素回归分析结果显示,SI、COPD、慢性肾功能不全、插管前使用肌松药与气管插管后低血压预后有关(P<0.05).其中SI与气管插管后发生低血压为最强相关的变量(OR 19.215,95%CI1.123~328.880),并且确定SI>0.89是插管后发生低血压的阈值.低血压组的病死率(40.0%)高于非低血压组(20.0%),差异有统计学意义(P<0.05).结论气管插管前偏高的SI、合并COPD和慢性肾功能不全基础疾病、插管前使用肌松药与急性低氧性呼吸衰竭患者气管插管后低血压相关.其中插管前SI可作为独立的预测因素,并且确定SI>0.89是预测插管后发生低血压的阈值.气管插管后低血压的发生可能会增加急性低氧性呼吸衰竭患者28 d死亡风险.

Analysis of risk factors and prognosis of postintubation hypotension in the patients with acute hypoxic respiratory failure

Objective To identify the risk factors and prognosis of postintubation hypotension in the patients with acute hypoxic respiratory failure.Methods The clinical data of 110 patients with acute hypoxic respiratory failure admitted to the Critical Care Medicine of the Affiliated Hospital of Xuzhou Medical University from January 2016 to March 2019 were enrolled in this study.According to the blood pressure after intubation,they were divided into two groups:postintubation hypotension group(n=35)and non-postintubation hypotension group(n=75).Multiple Logistic regression modeling was used to define the predictors of postintubation hypotension.The ROC survival curve was used to study the diagnostic value.Results There were statistically significant differences in systolic blood pressure(SBP),shock index(SI),using muscle relaxants,combined with COPD or chronic renal insufficiency in pre-intubation between the two groups(P<0.05).There were no significant differences in age,gender,other chronic diseases,other drugs pre-intubation except for muscle relaxants,and APACHE II scores(P>0.05).Multiple Logistic regression analysis demonstrated that S I,COPD,chronic renal disease and preintubation neuromuscular blockade were independently associated with postintubation hypotension(P<0.05).SI was the most strongly associated factor(OR 19.215,95%Cl 1.123-328.880).It was determined that SI over 0.89 was the threshold of postintuhation hypotension.The mortality rate of the postintubation hypotension(40.0%)was higher than that of the non-postintubation hypotension group(20.0%)(P<0.05).Conclusion High pre-intubation SI,combined with COPD,chronic renal disease and neuromuscular blockade are associated with postintubation hypotension in the patients with acute hypoxic respirator-failure.The pre-intubation SI can be used as an independent predictor,and SI over 0.890 is the threshold for predicting postintubation hypotension.The occurrence of postintubation hypotension may increase the risk of 28-day mortality in the patients with acute hypoxic respiratory failure.