[1]丁慧强,杨 辉.AECOPD伴呼吸衰竭患者短期内撤机拔管的影响因素分析[J].医学信息,2019,32(01):106-108.[doi:10.3969/j.issn.1006-1959.2019.01.032]
　DING Hui-qiang,YANG Hui.Analysis of Influencing Factors of Ablation of AECOPD Patients with Respiratory Failure in Short-term[J].Journal of Medical Information,2019,32(01):106-108.[doi:10.3969/j.issn.1006-1959.2019.01.032]
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AECOPD伴呼吸衰竭患者短期内撤机拔管的影响因素分析()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
32卷
期数:
2019年01期
页码:
106-108
栏目:
论著
出版日期:
2019-01-01

文章信息/Info

Title:
Analysis of Influencing Factors of Ablation of AECOPD Patients with Respiratory Failure in Short-term
文章编号:
1006-1959（2019）01-0106-03
作者:
丁慧强; 杨 辉
宣城市人民医院重症医学科，安徽 宣城 242000
Author(s):
DING Hui-qiang; YANG Hui
Department of Critical Care Medicine,Xuancheng People's Hospital,Xuancheng 242000,Anhui,China
关键词:
慢性阻塞性肺疾病; 机械通气; 白蛋白; 血红蛋白; 乳酸
Keywords:
Chronic obstructive pulmonary disease; Mechanical ventilation; Albumin; Hemoglobin;  Lactic acid
分类号:
R563.9
DOI:
10.3969/j.issn.1006-1959.2019.01.032
文献标志码:
A
摘要:
目的 研究慢性阻塞性肺疾病急性加重期伴呼吸衰竭患者短期内撤机拔管的影响因素。方法 回顾性分析AECOPD伴呼吸衰竭并经有创机械通气治疗成功撤机拔管的患者总共34例。入选患者根据有创机械通气的时间分为两组，即通气时间≤3 d组及通气时间＞3 d组。分别记录两组患者的性别、年龄、入科时的病程、APACHEⅡ评分、白蛋白、血红蛋白、红细胞分布宽度、C反应蛋白、降钙素原、乳酸等指标。将所有的指标进行单因素分析和多因素Logistic回归分析。结果 两组患者之间的性别、年龄、病程及APACHEⅡ评分比较，差异均无统计学意义（P＞0.05）。而通气时间≤3 d组患者血清白蛋白＜30 g/L、血红蛋白＜130 g/L患者数均少于通气时间＞3 d组，差异均有统计学意义（P＜0.05）。两组患者入科时红细胞分布宽度、C反应蛋白、降钙素原水平比较，差异无统计学意义（P＞0.05）。通气时间≤3 d组患者血乳酸＞2 mmol/L患者数少于通气时间＞3 d组，差异有统计学意义（P＜0.05）。多因素Logistic回归分析示入科时血乳酸水平是慢性阻塞性肺疾病急性加重期患者有创机械通气时间＞3 d独立的危险因素（P＜0.05）。结论 白蛋白、血红蛋白、乳酸均是AECOPD伴呼吸衰竭患者短期内撤机拔管的影响因素，其中患者入科时的血乳酸水平是慢性阻塞性肺疾病急性加重期患者有创机械通气时间＞3 d独立的危险因素，积极干预处理影响因素，对患者尽早撤机拔管有重要意义。
Abstract:
Objective To study the influencing factors of short-term extubation and extubation in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure.Methods A total of 34 patients with AECOPD with respiratory failure and successful intubation with invasive mechanical ventilation were retrospectively analyzed. The enrolled patients were divided into two groups according to the time of invasive mechanical ventilation, that is, the ventilation time ≤ 3 d group and the ventilation time > 3 d group. The gender, age, duration of illness, APACHE II score, albumin, hemoglobin, red blood cell distribution width, C-reactive protein, procalcitonin, lactic acid and other indicators were recorded. All indicators were analyzed by univariate analysis and multivariate logistic regression analysis.Results There were no significant differences in gender, age, duration of disease and APACHE II score between the two groups (P>0.05).However, the number of patients with serum albumin < 30 g / L and hemoglobin < 130 g / L in ventilation time ≤ 3 d group was less than that in ventilation time > 3 d group,the differences were statistically significant (P<0.05). There was no significant difference in the distribution of red blood cells, C-reactive protein and procalcitonin levels between the two groups (P>0.05). The number of patients with blood lactic acid >2 mmol/L in the ventilatory time ≤3 d group was less than that in the ventilation group >3 d group, the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that blood lactate level was a risk factor for invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease >3 d (P<0.05).Conclusion Albumin, hemoglobin and lactic acid are the influencing factors of AECOPD patients with respiratory failure in the short-term withdrawal. The blood lactate level of patients with acute obstructive pulmonary disease is the invasive mechanical ventilation time of patients with acute exacerbation of chronic obstructive pulmonary disease >3 d Independent risk factors, active intervention to deal with the influencing factors, the importance of early withdrawal and extubation of patients.

参考文献/References:

[1]姚婉贞.慢性阻塞性肺疾病诊治指南(2007年修订版)[J].中华结核和呼吸杂志,2007,30(1):8-17.
[2]中华医学会重症医学分会.慢性阻塞性肺疾病急性加重患者的机械通气指南(2007)[J].中国危重病急救医学,2007,19(9):513-518.
[3]刘大为.实用重症医学[M].2版.北京:人民卫生出版社,2017:563.
[4]万芳竹,李媛媛,崔德芝.慢性阻塞性肺疾病营养不良的研究进展[J].山东医药,2015,55(29):101-103.
[5]李国翔,赵京梅,王永红.营养状况与慢性阻塞性肺疾病急性加重的相关性研究[J].临床肺科杂志,2017,22(01):73-76.
[6]崔凯铭,单锡峥,汪志方.血清白蛋白水平对老年COPD急性加重期合并呼吸衰竭患者转归的影响[J].山东医药,2015,55(34):46-47.
[7]冯璇璘,梁宗安,董芸,等.血红蛋白浓度变化对机械通气患者脱机结果的预测价值[J].实用医院临床杂志,2014,11(2):75-77.
[8]雷燕妮,陈必耀,杨铁城.轻度高乳酸血症是急诊危重患者死亡的独立危险因素[J].中国急救复苏与灾害医学杂志,2016,10(8):776-778.
[9]高新海,徐仲卿,赵文穗.动态血乳酸监测与APACHEII评分对危重患者预后的评估[J].河北医学,2013,19(1):34-37.
[10]王传永,常晓悦.24小时乳酸清除率对109例慢阻肺急性期合并高乳酸血症患者预后的评估价值[J].临床肺科杂志,2015,20(4):676-678.

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更新日期/Last Update: 2019-01-22