重症监护病房长期机械通气患者撤机困难的原因及死亡影响因素分析

目的:探讨重症监护病房(ICU)长期机械通气患者撤机困难的原因及撤机死亡的影响因素。方法:对2015年6月至2018年10月我院收治的80例长期机械通气患者的临床资料进行回顾性分析,按照患者撤机结果分为撤机成功组52例和撤机困难组28例,根据患者存活情况分为存活组59例和死亡组21例。比较各组临床资料,分析撤机困难的原因及撤机死亡的影响因素。结果:撤机困难组年龄、心功能不全比例、多器官功能障碍(MODS)比例、呼吸机相关肺炎(VAP)比例、肝功能不全比例、肾功能不全比例、血尿素氮显著高于撤机成功组,机械通气时间、气管切开时间显著长于撤机成功组,血清白蛋白显著低于撤机成功组(P0.05)。死亡组年龄、合并糖尿病比例、心功能不全比例、MODS比例、VAP比例、肝功能不全比例、肾功能不全比例、血尿素氮显著高于存活组,机械通气时间、气管切开时间显著长于存活组,血清白蛋白显著低于存活组(P0.05)。多因素Logistic回归分析显示:年龄、合并糖尿病、MODS、VAP、机械通气时间、气管切开时间、血清白蛋白是ICU长期机械通气患者撤机死亡的影响因素(P0.05)。结论:患者治疗期间发生脏器功能不全或器官功能衰竭、机械通气时间较长、气管切开时间较长、营养状态较差是长期机械通气患者撤机困难的主要原因,年龄、合并糖尿病、MODS、VAP、机械通气时间、气管切开时间、血清白蛋白是ICU长期机械通气患者撤机死亡的影响因素。

Causes of Difficulty in Weaning Patients with Long-term Mechanical Ventilation in Intensive Care Unit and Influencing Factors of Death

ABSTRACT Objective: To explore the causes of difficulty in weaning patients with long-term mechanical ventilation in intensive care unit (ICU) and the influencing factors of death. Methods: The clinical data of 80 patients with long-term mechanical ventilation who were admitted to our hospital from June 2015 to October 2018 were retrospectively analyzed. All the patients were divided into successful weaning group (52 cases), difficult weaning group (28 cases) according to the results of weaning. The patients were divided into survival group (59 cases) and death group (21 cases) depending on patient survival. The clinical data of each group were compared, and the causes of difficult weaning and the influencing factors of death were analyzed. Results: The age, cardiac insufficiency ratio, multiple organ dysfunction (MODS) ratio, ventilator-associated pneumonia (VAP) ratio, liver insufficiency ratio, renal insufficiency ratio, blood urea nitrogen in the difficult weaning group were significantly higher than those in the successful weaning group. The mechanical ventilation time and tracheotomy time were significantly longer than those in the successful weaning group, and serum albumin was significantly lower than that in the successful weaning group (P<0.05). Age, complicated with diabetes mellitus ratio, cardiac insufficiency ratio, MODS ratio, VAP ratio, liver insufficiency ratio, renal insufficiency ratio, blood urea nitrogen in the death group were significantly higher than those in the survival group, mechanical ventilation time and tracheotomy time were significantly longer than those in the survival group, and serum albumin was significantly lower than that in the survival group (P<0.05). Multivariate logistic regression analysis showed that age, complicated with diabetes mellitus, MODS, VAP, mechanical ventilation, tracheotomy time, serum albumin were the influencing factors of weaning death in ICU patients with long-term mechanical ventilation (P<0.05). Conclusion: During the treatment period, the main causes of difficulty in weaning patients with long-term mechanical ventilation are organ dysfunction or organ failure, longer mechanical ventilation time, longer tracheotomy time and poor nutritional status. The age, complicated with diabetes mellitus, MODS, VAP, mechanical ventilation time, tracheotomy time, serum albumin are the influencing factors of weaning death in ICU patients with long-term mechanical ventilation.