老年AECOPD合并呼吸衰竭患者无创呼吸机撤机失败的危险因素分析OA
Analysis of risk factors for noninvasive ventilator weaning failure in elderly AECOPD patients complicated with respiratory failure
目的 探讨老年慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者无创呼吸机(NIV)撤机失败的危险因素.方法 回顾性分析2022-2023年在重庆市永川区人民医院住院治疗的103例老年AECOPD合并呼吸衰竭患者的临床资料.根据NIV撤机结果分为成功组(n=73)和失败组(n=30).比较两组一般资料、实验室检查指标、血气分析指标及呼吸机参数与使用情况,多因素logistic回归分析老年AECOPD合并呼吸衰竭患者NIV撤机失败的危险因素.结果 失败组年龄大于成功组,入院时急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、合并心力衰竭、冠心病和糖尿病的比例、WBC、中性粒细胞百分比、C反应蛋白(CRP)、降钙素原(PCT)、D-二聚体(D-D)、血乳酸、N末端脑钠肽前体(NT-proBNP)、血清钾、PaCO2 水平高于成功组,格拉斯哥昏迷量表(GCS)评分、pH、PaO2 及氧合指数[PaO2/吸入氧浓度(FiO2)]水平低于成功组,NIV使用时间长于成功组,差异均有统计学意义(P<0.05).多因素logistic回归分析显示,APACHEⅡ评分高、合并心力衰竭、CRP、PCT、NT-proBNP、PaCO2 高水平、NIV使用时间长是老年 AECOPD合并呼吸衰竭患者NIV撤机失败的独立危险因素(P<0.05),GCS评分高是老年 AECOPD合并呼吸衰竭患者 NIV撤机失败的独立保护因素(P<0.05).结论 老年AECOPD合并呼吸衰竭患者NIV撤机失败与多种因素相关,临床应综合评估这些因素,制订个体化撤机策略,优化治疗,密切监测,以改善患者预后.
Objective To investigate the risk factors for non-invasive ventilation(NIV)weaning failure in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated by respiratory failure.Methods A retrospective analysis was conducted on the clinical data of 103 elderly pa-tients with AECOPD combined with respiratory failure who were hospitalized at the Yongchuan District Peo-ple's Hospital in Chongqing from 2022 to 2023.According to the NIV weaning outcome,the patients were di-vided into a success group(n=73)and a failure group(n=30).The general data,laboratory test indicators,blood gas analysis indicators,and ventilator parameters and usage were compared between the two groups.Multivariate logistic regression analysis was performed to identify the risk factors for NIV weaning failure in elderly patients with AECOPD combined with respiratory failure.Results The age of the failure group was higher than that of the success group in elderly patients with AECOPD.The Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,the proportions of patients with comorbid heart failure,coronary heart disease and diabetes,and the levels of WBC,neutrophil percentage,C-reactive protein(CRP),procalcito-nin(PCT),D-dimer(D-D),blood lactate,N-terminal pro-brain natriuretic peptide(NT-proBNP),serum po-tassium,and arterial partial pressure of carbon dioxide(PaCO2)were higher in the failure group than in the success group.The Glasgow Coma Scale(GCS)score,pH,arterial partial pressure of oxygen(PaO2),and ox-ygenation index[PaO2/inspired oxygen fraction(FiO2)]were lower in the failure group than in the success group.The duration of non-invasive ventilation(NIV)use was longer in the failure group than in the success group.All these differences were statistically significant(P<0.05).Multivariate logistic regression analysis revealed that a high APACHE Ⅱ score,comorbid heart failure,high levels of CRP,PCT,NT-proBNP,and PaCO2,and a long duration of NIV use were independent risk factors for NIV weaning failure in elderly pa-tients with AECOPD complicated with respiratory failure(P<0.05),while a high GCS score was a protective factor(P<0.05).Conclusion Weaning failure from NIV in elderly AECOPD patients with respiratory fail-ure is associated with multiple factors.Clinically,these factors should be comprehensively assessed to develop individualized weaning strategies,optimize treatment,and monitor closely,with the aim of improving patient prognosis.
王利;何菲
重庆市永川区人民医院呼吸与危重症医学科,重庆 402160重庆医科大学附属永川医院老年医学科,重庆 402160
医药卫生
老年慢性阻塞性肺疾病急性加重期呼吸衰竭无创呼吸机撤机失败危险因素
old ageacute exacerbation of chronic obstructive pulmonary diseaserespiratory failurenon-invasive ventilatorweaning failurerisk factors
《重庆医学》 2026 (4)
853-858,6
重庆市永川区技术创新与应用发展专项面上项目(2021yc-cxfz30017).
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