| 佟媛旭,赵 君,卫飞燕,刘 龙,魏雅丽.AECOPD并重度呼吸衰竭患者有创机械通气的治疗时机探讨及其预后的影响因素分析[J].,2023,(9):1651-1655 |
| AECOPD并重度呼吸衰竭患者有创机械通气的治疗时机探讨及其预后的影响因素分析 |
| Discussion on the Timing of Treatment of Invasive Mechanical Ventilation in Patients with AECOPD Combined with Severe Respiratory Failure and Analysis of the Influencing Factors of Prognosis |
| 投稿时间：2022-08-30 修订日期：2022-09-26 |
| DOI：10.13241/j.cnki.pmb.2023.09.010 |
| 中文关键词: AECOPD 重度呼吸衰竭 有创机械通气 治疗时机 预后 |
| 英文关键词: AECOPD Severe respiratory failure Invasive mechanical ventilation Timing of treatment Prognosis |
| 基金项目:北京市自然科学基金项目（7153169） |
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| 中文摘要: |
| 摘要 目的：探讨慢性阻塞性肺疾病急性加重（AECOPD）合并重度呼吸衰竭患者有创机械通气的治疗时机，并分析其预后的影响因素。方法：选取2020年3月~2021年12月期间于首都医科大学附属北京世纪坛医院治疗的161例AECOPD合并重度呼吸衰竭患者，按照气管插管时间分为早期组（n=89）和延期组（n=72），对比两组治疗后临床指标、血气分析指标及28 d内病死率（预后）。根据预后的不同将患者分为死亡组（n=29）和存活组（n=132），收集患者的一般资料和实验室资料，采用Logistic回归分析预后的影响因素。结果：早期组的总机械通气时间、有创通气时间、重症监护室（ICU）住院时间均短于延期组（P<0.05）。两组治疗后动脉血二氧化碳分压（PaCO2）较治疗前下降，氧合指数（OI）、动脉血氧分压（PaO2）较治疗前升高，且早期组变化程度大于延期组（P<0.05）。延期组28 d内病死率为15/72（20.83%）。早期组28 d内病死率为14/89（15.73%），两组患者的28 d病死率对比无差异（P>0.05）。单因素分析结果显示，AECOPD合并重度呼吸衰竭患者的预后影响因素与并发呼吸机相关肺炎、并发多脏器功能不全综合征、年龄、PaCO2、血红蛋白（Hb）、血尿素氮（BUN）、白细胞计数（WBC）、pH值、中性粒细胞计数/淋巴细胞计数比值（NLR）、血小板计数/淋巴细胞计数（PLR）、C反应蛋白（CRP）、D-二聚体（D-D）、B型尿钠肽有关（P<0.05）。AECOPD合并重度呼吸衰竭患者预后不良的危险因素主要有并发呼吸机相关肺炎、并发多脏器功能不全综合征、PaCO2偏高、年龄偏大、Hb偏低、pH值偏低、D-D偏高（P<0.05）。结论：AECOPD合并重度呼吸衰竭患者早期使用有创机械通气，可有效改善血气分析，缩短有创通气时间、总机械通气时间、ICU住院时间。并发呼吸机相关肺炎、并发多脏器功能不全综合征、PaCO2偏高、年龄偏大、Hb偏低、pH值偏低、D-D偏高均是导致AECOPD合并重度呼吸衰竭患者预后不良的危险因素。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the timing of treatment of invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with severe respiratory failure, and to analyze the prognostic influencing factors. Methods: 161 patients with AECOPD combined with severe respiratory failure who were treated in Beijing Shijitan Hospital Affiliated to Capital Medical University from March 2020 to December 2021 were selected, they were divided into early group (n=89) and delayed group (n=72) according to the time of endotracheal intubation, the clinical indicators, blood gas analysis indicators and mortality (prognosis) within 28 d were compared after treatment between the two groups. Patients were divided into death group (n=29) and survival group (n=132) according to different prognosis, the general and laboratory data of patients were collected, univariate and multivariate Logistic regression were used to analyze the influencing factors on the prognosis of patients with AECOPD combined with severe respiratory failure. Results: The invasive ventilation time, total mechanical ventilation time, and intensive care unit(ICU) hospitalization time in the early group were shorter than those in the delayed group (P<0.05). The arterial partial pressure of carbon dioxide (PaCO2) in two groups decreased after treatment compared with before treatment, the oxygenation index (OI), and arterial partial pressure of oxygen (PaO2) were higher than that before treatment, and the degree of change in the early group was greater than that in the delayed group (P<0.05). The mortality rate within 28 d in the delayed group was 15/72 (20.83%). The mortality rate within 28 d in the early group was 14/89 (15.73%), there was no difference in 28 d mortality rate of patients between the two groups (P>0.05). The results of the univariate analysis showed that influencing factors on the prognosis of patients with AECOPD combined with severe respiratory failure were concurrent ventilator-associated pneumonia, concurrent multiple organ insufficiency syndrome, age, PaCO2, hemoglobin (HB), blood urea nitrogen (BUN), white blood cell count (WBC), pH value, neutrophil count / lymphocyte count ratio (NLR), platelet count / lymphocyte count (PLR), C-reactive protein (CRP), D-Dimer (D-D), and B-type natriuretic peptide was associated (P<0.05). The results of multivariate Logistic regression analysis showed that concurrent ventilator-associated pneumonia, concurrent multiple organ insufficiency syndrome, higher PaCO2, older age, lower Hb, lower pH value and higher D-D were risk factors for poor prognosis in patients with AECOPD combined with severe respiratory failure (P<0.05). Conclusion: Early use of invasive mechanical ventilation in patients with AECOPD combined with severe respiratory failure, it can effectively improve blood gas analysis, reduce invasive ventilation time, total mechanical ventilation time, ICU hospitalization time. Concurrent ventilator-associated pneumonia, concurrent multiple organ insufficiency syndrome, higher PaCO2, older age, lower Hb, lower pH value and higher D-D both are leading to risk factors for poor prognosis in patients with AECOPD combined with severe respiratory failure. |
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