慢性阻塞性肺疾病急性加重期病人有创机械通气撤机失败原因分析

目的:探讨慢性阻塞性肺疾病急性加重期（AECOPD）病人在使用有创机械通气治疗后撤机失败的原因。方法:回顾分析接受有创机械通气的78例AECOPD病人的病情资料，根据病人撤机成功与否分组，采用logistic回归分析，分析年龄、COPD病程、有创通气时间、平均动脉压、血清白蛋白水平、急性生理与慢性健康Ⅱ评分、入住ICU时间、基础疾病（如高血压、糖尿病、高血脂等）等与撤机失败的关系。结果:78例病人中有53例（67.95%）撤机成功，25例（32.05%）撤机失败。logistic回归分析提示，年龄较大、有创通气时间较长、血清白蛋白较低和合并有高血压或糖尿病是AECOPD病人有创通气撤机失败的独立危险因素（P<0.01）。结论:多种因素作用导致AECOPD病人有创机械通气撤机失败，其中年龄较大、有创通气时间较长、血清白蛋白较低、合并有高血压或糖尿病，都是AECOPD病人有创机械通气撤机失败的独立危险因素。

Analysis of the causes of weaning failure of invasive mechanical ventilation in patients with chronic obstructive pulmonary disease in acute exacerbation

Objective:To investigate the causes of weaning failure in patients with acute exacerbation of chronic obstructive pulmonary disease( AECOPD) after invasive mechanical ventilation. Methods:The clinical data of 78 AECOPD patients treated with mechanical ventilation were retrospectively analyzed. According to the success weaning of patients, the relationships between the age, duration of COPD,duration of invasive ventilation,mean arterial pressure,serum albumin level,acute physiology and chronic healthⅡ scores,ICU stay time,underlying diseases( such as hypertension, diabetes, hyperlipidemia, etc. ) and weaning failure were analyzed using logistic regression analysis method. Results:Among 78 patients,the weaning success in 53 cases(67. 95％) and weaning failure in 25 cases (32. 05％) were found. The results of logistic regression analysis showed that the old age,long duration of invasive ventilation,low serum albumin and hypertension or diabetes mellitus were the independent risk factors of invasive ventilatory failure in AECOPD patients(P<0. 01). Conclusions:A variety of factors can lead to the failure of invasive mechanical ventilation in patients with AECOPD. The old age, long invasive ventilation, low serum albumin, and hypertension or diabetes mellitus are the independent risk factors of invasive ventilatory failure in AECOPD patients.