摘要
目的分析严重呼吸衰竭患者早期肺康复后撤机失败的影响因素。方法选取2020年1月至2022年1月广西壮族自治区钦州市第一人民医院收治的135例严重呼吸衰竭患者作为研究对象,统计严重呼吸衰竭患者早期肺康复后撤机情况,分析影响撤机失败的因素。结果与撤机成功严重呼吸衰竭患者比较,撤机失败患者ICU住院、带管、呼吸机使用时间较长,并发症发生率较高(P<0.05)。单因素分析所示,严重呼吸衰竭患者早期肺康复后撤机失败与性别、入住ICU时间、BMI、平均动脉压无关(P>0.05);严重呼吸衰竭患者早期肺康复后撤机失败与年龄、合并基础疾病、NYHA心功能分级、多器官衰竭、血清白蛋白、CK-MB、cTnI、机械通气时间、APACHEⅡ评分、SOFA评分、PETCO_(2)有关,≥65岁、合并基础疾病、NYHA心功能分级Ⅲ~Ⅳ级、多器官衰竭者、血清白蛋白<210×10^(9)/L、CK-MB≥6 U/L、cTnI≥120μg/L、机械通气时间≥10 d、APACHEⅡ评分≥20分、SOFA评分≥5分、PETCO_(2)≥40 mm Hg的严重呼吸衰竭患者早期肺康复后撤机失败发生率较高(P<0.05)。以严重呼吸衰竭患者早期肺康复后撤机情况为因变量(成功=0,失败=1),选择单因素分析中P<0.05的变量进行多因素Logistics回归分析,结果显示年龄、合并基础疾病、NYHA心功能分级、多器官衰竭、血清白蛋白、CK-MB、cTnI、机械通气时间、APACHEⅡ评分、SOFA评分、PETCO_(2)为影响严重呼吸衰竭患者早期肺康复后撤机失败的主要因素(P<0.05)。结论年龄、合并基础疾病、NYHA心功能分级、多器官衰竭、血清白蛋白、CK-MB、cTnI、机械通气时间、APACHEⅡ评分、SOFA评分、PETCO_(2)均为严重呼吸衰竭患者早期肺康复后撤机失败的影响因素。
Objective To analyze the influencing factors for the failure of weaning after early pulmonary rehabilitation in patients with severe respiratory failure.Methods A total of 135 patients with severe respiratory failure admitted to the First People’s Hospital of Qinzhou from January 2020 to January 2022 were selected as the research objects.Weaning after early pulmonary rehabilitation was analyzed,and influencing factors for the failure of weaning were analyzed.Results Compared with those of success weaning,patients with severe respiratory failure and failure of weaning presented significantly longer stay in the intensive care unit(ICU),longer tube and ventilator use time,and higher complication rate(P<0.05).Univariate analysis showed that the failure of weaning after early pulmonary rehabilitation in patients with severe respiratory failure was not correlated with gender,length of stay in ICU,body mass index(BMI),and mean arterial pressure(P>0.05).The failure of weaning after early pulmonary rehabilitation in patients with severe respiratory failure was significantly correlated with the age,combined with underlying diseases,the New York Heart Association(NYHA)Functional Classification,multiple organ failure,serum albumin,Creatine Kinase MB(CK-MB),cardiac troponin I(cTnI),mechanical ventilation time,the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,the Sequential Organ Failure Assessment(SOFA)score and partial pressure of end-tidal CO_(2)(PetCO_(2)).Patients with severe respiratory failure who had≥65 years old,combined with underlying diseases,NYHA cardiac function gradeⅢ-Ⅳ,multiple organ failure,serum albumin<210×10^(9)/L,CK-MB≥6U/L,cTnI≥120μg/L,mechanical ventilation time≥10d,APACHEⅡscore≥20 points,SOFA score≥5 points and PetCO_(2)≥40mmHg had the significantly higher risk of failure of weaning(P<0.05).Taking the weaning status after early pulmonary rehabilitation in patients with severe respiratory failure as the dependent variable(success=0,failure=1),variables with P<0.05 in the univariate analysis were selected for multivariate logistic regression analysis.The results showed that age,combined with underlying diseases,NYHA Functional Classification,multiple organ failure,serum albumin,CK-MB,cTnI,mechanical ventilation time,APACHEⅡscore,SOFA score,PetCO_(2) were the main factors affecting the failure of weaning after early pulmonary rehabilitation in patients with severe respiratory failure(P<0.05).Conclusion Age,combined with underlying diseases,NYHA Functional Classification,multiple organ failure,serum albumin,CK-MB,cTnI,mechanical ventilation time,APACHEⅡscore,SOFA score and PetCO_(2) are all influencing factors for the failure of weaning after early pulmonary rehabilitation in patients with severe respiratory failure.
作者
宋振芳
彭先美
欧平雪
刘建鹏
SONG Zhenfang;PENG Xianmei;OU Pingxue(Department of Respiratory and Critical Care Medicine,the First People’s Hospital of Qinzhou,Guangxi,Qinzhou 535000,China;不详)
出处
《河北医药》
CAS
2024年第3期372-375,379,共5页
Hebei Medical Journal
基金
广西壮族自治区卫生健康委员会自筹经费科研课题(编号:Z20201154)。
关键词
严重呼吸衰竭
早期肺康复
撤机失败
影响因素
severe respiratory failure
early pulmonary rehabilitation
failure of weaning
influencing factor
