摘要
目的调查老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)伴呼吸衰竭患者机械通气后拔管失败情况,并对其危险因素进行分析。方法选取2020年7月—2024年2月南阳市中心医院收治的230例老年AECOPD伴呼吸衰竭患者,均接受有创机械通气治疗,记录治疗后的拔管撤机情况,并根据经治疗后是否成功拔管撤机分为成功组和失败组,收集两组患者临床相关资料,单、多因素分析影响患者拔管撤机失败的危险因素,并利用ROC曲线验证多因素回归分析模型价值。结果230例老年AECOPD伴呼吸衰竭患者中有67例患者出现拔管撤机失败,发生率为29.13%。单因素分析显示,成功组年龄<70岁、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)病程<10年、AECOPD病程<5 d、AECOPD发病频率为3次/年急性生理功能和慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分<20分、格拉斯哥昏迷评分(glasgow coma scale,GCS)≥9分、无糖尿病、无多器官功能衰竭、无吸烟史、机械通气时间<7 d、机械通气治疗24 h后动脉血碳氧分压(partial pressure of carbon oxygen,PaCO_(2))<80 mmHg、机械通气治疗24 h后动脉血氧分压(partial pressure of oxygen,PaO_(2))≥50 mmHg、拔管时白细胞计数(white blood cell,WBC)<10×10^(9)/L、拔管时白蛋白(albumin,ALB)≥30 g/L的占比分别为47.85%、69.33%、71.17%、82.85%、60.12%、82.21%、65.64%、87.12%、68.10%、77.30%、79.75%、75.46%、87.12%、22.70%,均高于失败组的25.37%、38.81%、52.24%、34.33%、38.81%、44.78%、44.78%、58.21%、10.45%、46.27%、23.88%、31.34%、5.97%,差异有统计学意义(P<0.05)。多因素分析显示,年龄≥70、合并糖尿病、MODS、存在吸烟史、机械通气时间≥7 d、机械通气治疗24 h后PaCO_(2)≥80 mmHg、拔管时ALB<30 g/L是影响患者发生拔管撤机失败的独立危险因素(P<0.05)。ROC分析显示,多因素回归分析模型预测拔管撤机失败的AUC为0.787,95%CI为0.693~0.881(P<0.001)。结论老年AECOPD伴呼吸衰竭患者发生拔管撤机失败风险高;临床需对具有以上独立危险因素的人群进行重点关注,强化治疗方案,减少失败风险,提高临床疗效,改善患者预后。
Objective To investigate extubation failure and analyze its risk factors in elderly patients with acute exacer-bation of chronic obstructive pulmonary disease(AECOPD)and respiratory failure after mechanical ventilation.Methods A total of 230 elderly patients with AECOPD and respiratory failure who underwent invasive mechanical ventilation in Nanyang Central Hospital were enrolled between July 2020 and February 2024.The extubation weaning after treatment was recorded.According to extubation status,patients were divided into success group and failure group.The clinical data in the two groups were collected.The risk factors of extubation failure were analyzed by univariate and multivariate analysis.The value of multivariate regression analysis model was verified by ROC curves.Results Among the 230 elderly patients with AECOPD and respiratory failure,there were 67 cases(29.13%)with extubation failure.Univariate analysis showed that proportions of age<70 years,course of chronic obstructive pulmonary disease(COPD)<10 years,AECOPD course<5d,onset frequency of AECOPD≤3 years,score of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)<20 points,score of Clasgow coma scale(GCS)≥9 points,no diabetes mellitus,no multiple organ failure,no smoking history,mechanical ventilation time<7 d,partial pressure of carbon oxygen(PaCO_(2))<80 mmHg after 24 h of mechanical ventilation,partial pressure of oxygen(PaO_(2))≥50mmHg after 24 h of mechanical ventilation,white blood cell(WBC)<10×10^(9)/L immediately after extubation and albumin(ALB)≥30 g/L immediately after extubation in success group were 47.85%,69.33%,71.17%,82.85%,60.12%,82.21%,65.64%,87.12%,68.10%,77.30%,79.75%,75.46%,87.12% and 22.70%,higher than 25.37%,38.81%,52.24%,34.33%,38.81%,44.78%,44.78%,58.21%,10.45%,46.27%,23.88%,31.34% and 5.97% in failure group(P<0.05).Multivariate analysis showed that age≥70 year,diabetes mellitus,MODS,smoking history,mechanical ventilation time≥7 d,PaCO,≥80mmHg after 24 h of mechanical ventilation and ALB≥30g/L immediately after extubation were independent risk factors of extubation failure(P<0.05).ROC curves analysis showed that AUC and 95% CI of multivariate regression analysis model for predicting extubation failure were 0.787 and 0.693-0.881(P<0.001).Conclusion The risk of extubation failure is high in elderly patients with AECOPD and respiratory failure.Clinically,close attentions should be paid to patients with the above factors and therapeutic regimen should be strengthened to reduce failure risk,improve clinical curative effect and prognosis of patients.
作者
吴哲
董万里
李克芳
许学宗
WU Zhe;DONG Wan-li;LI Ke-fang;XU Xue-zong(Department of Respiratory and Critical Care Medicine,Nanyang Central Hospital,Nanyang,Henan 473000,China)
出处
《医药论坛杂志》
2025年第15期1597-1602,共6页
Journal of Medical Forum
关键词
慢性阻塞性肺疾病急性加重期
呼吸衰竭
机械通气
拔管失败
危险因素
Acute exacerbation of chronic obstructive pulmonary disease
Respiratory failure
Mechanical ventilation
Extubation failure
Risk factor
