慢性阻塞性肺疾病急性加重期患者有创呼吸机辅助通气撤机失败的原因分析

目的:分析慢性阻塞性肺疾病急性加重期(AECOPD)患者有创呼吸机辅助通气撤机失败的原因。方法:回顾性分析2016年12月至2018年7月该院收治的42例AECOPD患者的临床资料,均在达到撤机标准后进行撤机,根据48 h内撤机成功与否分为成功组22例与失败组20例。分析AECOPD患者有创呼吸机辅助通气撤机失败的原因。结果:42例AECOPD患者中,20例48 h内撤机失败,发生率47.6%;两组性别、病程、吸烟史、合并脓毒症和平均动脉压水平比较,差异均无统计学意义(P>0.05);单因素分析结果显示,失败组年龄>60岁、通气时间>5 d、急性生理功能和慢性健康状况评分系统Ⅱ评分>31分、脑钠肽(BNP)>100 pg/mL、白细胞计数(WBC)<4×10⁹/L、C反应蛋白(CRP)>10 mg/L、降钙素原(PCT)≥0.5 ng/L及血糖≥6.1 mmol/L占比均明显高于成功组,差异有统计学意义(P<0.05);多因素Logistic分析结果显示,WBC<4×10⁹/L、CRP>10 mg/L和PCT≥0.5 ng/L均不是AECOPD患者撤机失败的独立危险因素(P>0.05);年龄>60岁、APACHEⅡ评分>31分、通气时间>5 d、BNP>100 pg/mL和血糖≥6.1 mmol/L均是AECOPD患者撤机失败的独立危险因素。结论:年龄>60岁、APACHEⅡ评分>31分、通气时间>5 d、BNP>100 pg/mL和血糖≥6.1 mmol/L均是AECOPD患者有创呼吸机辅助通气撤机失败的独立危险因素。

Reasons for weaning failure of invasive ventilator-assisted ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

Objective:To analyze reasons for weaning failure of invasive ventilator-assisted ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:The clinical data of 42 AECOPD patients admitted to the hospital from December 2016 to July 2018 were retrospectively analyzed.All the patients were weaned after reaching the weaning standards.According to the success or failure of weaning within 48 hours,they were divided into success group(22 cases)and failure group(20 cases).The reasons for weaning failure of invasive ventilator-assisted ventilation of them were analyzed.Results:Among the 42 patients with AECOPD,20 failed to be weaned within 48 hours,and the incidence was 47.6%.There were no statistically significant differences between the two groups in the gender,course of disease,smoking history,combined sepsis and mean arterial pressure level(P>0.05).The univariate analysis showed that the proportion of the patients with age>60 years,ventilation time>5 days,APACHE II score>31 points,BNP>100 pg/mL,WBC<4×10⁹/L,CRP>10 mg/L,PCT≥0.5 and blood glucose level≥6.1 mmol/L in the failure group was significantly higher than that in the success group,and the difference was statistically significant(P<0.05).The multivariate Logistic analysis showed that WBC<4×10⁹/L,CRP>10 mg/L and PCT≥0.5 ng/L were not the independent risk factors for weaning failure(P>0.05);however,age>60 years old,APACHE II score>31 points,ventilation time>5 days,BNP>100 pg/mL,and blood glucose≥6.1 mmol/L were the independent risk factors for weaning failure.Conclusions:Age>60 years old,APACHE II score>31 points,ventilation time>5 days,BNP>100 pg/mL and blood glucose≥6.1 mmol/L are the independent risk factors for weaning failure of invasive ventilator-assisted ventilation in the patients with AECOPD.