CAJ | 학술논문

目的探讨内科重症监护病房( MICU)患者撤机困难的相关因素.方法回顾分析2010年4月至2011年4月收治的112例接受呼吸机辅助通气患者的临床资料,其中男63例,女49例,年龄(58±26)岁；基础疾病主要包括慢性阻塞性肺疾病急性加重(AECOPD) 27例、肺炎20例、哮喘12例、神经肌肉疾病8例等.记录患者入院时基本情况、基础疾病、伴随疾病情况及撤机前的生理指标变化.将患者分为成功撤机组和撤机困难组,应用Logistic回归分析等分析与撤机困难有关的危险因素.结果撤机困难患者共27例(24.1％),其中基础疾病在两组间的分布差异有统计学意义的是:AECOPD(x2=6.238,P=0.028)、特发性肺纤维化(x2=5.232,P=0.025)、神经肌肉疾病(x2=14.635,P=0.007),撤机困难比例分别为9/27、2/6、6/8；两组间入院时氧合指数及撤机前氧合指数差异均有统计学意义(=2.183,2.162,均P＜0.05)；两组间撤机前的Zubrod评分差异有统计学意义(t =9.037,P＜0.05)；Logistic回归结果显示:严重心功能不全、精神心理疾病、阻塞性睡眠呼吸暂停、AECOPD及神经肌肉疾病的患者更易出现撤机困难(OR值分别为5.781、4.654、4.012、3.617及2.885).结论严重心功能不全、精神心理疾病、阻塞性睡眠呼吸暂停、AECOPD、神经肌肉疾病是MICU患者撤机困难的主要危险因素；患者的氧合功能以及自主行为能力也对撤机产生影响.
목적 탐토내과중증감호병방( MICU)환자철궤곤난적상관인소.방법 회고분석2010년4월지2011년4월수치적112례접수호흡궤보조통기환자적림상자료,기중남63례,녀49례,년령(58±26)세；기출질병주요포괄만성조새성폐질병급성가중(AECOPD) 27례、폐염20례、효천12례、신경기육질병8례등.기록환자입원시기본정황、기출질병、반수질병정황급철궤전적생리지표변화.장환자분위성공철궤조화철궤곤난조,응용Logistic회귀분석등분석여철궤곤난유관적위험인소.결과 철궤곤난환자공27례(24.1％),기중기출질병재량조간적분포차이유통계학의의적시:AECOPD(x2=6.238,P=0.028)、특발성폐섬유화(x2=5.232,P=0.025)、신경기육질병(x2=14.635,P=0.007),철궤곤난비례분별위9/27、2/6、6/8；량조간입원시양합지수급철궤전양합지수차이균유통계학의의(=2.183,2.162,균P＜0.05)；량조간철궤전적Zubrod평분차이유통계학의의(t =9.037,P＜0.05)；Logistic회귀결과현시:엄중심공능불전、정신심리질병、조새성수면호흡잠정、AECOPD급신경기육질병적환자경역출현철궤곤난(OR치분별위5.781、4.654、4.012、3.617급2.885).결론 엄중심공능불전、정신심리질병、조새성수면호흡잠정、AECOPD、신경기육질병시MICU환자철궤곤난적주요위험인소；환자적양합공능이급자주행위능력야대철궤산생영향.
Objective To explore the related factors of difficult-to-wean patients in medical intensive care unit (MICU).Methods A retrospective analysis was performed for 112 patients placed on mechanical ventilation.There were 63 males and 49 females with a mean age of (58 ± 26) years.Their primary diseases included acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (n =27 ),pneumonia ( n =20),asthma ( n =12) and neuromuscular diseases ( n =8 ).Basic admission profiles,underlying diseases,accompanying diseases and pre-weaning changes in physiological indicators were recorded.They were divided into 2 groups:successfully-weaned group and different-to-wean group.Logistic regression analysis was used to analyze the risk factors correlated with the difficult withdrawal of mechanical ventilation.Results There were 27 (24.1％ ) diffficult-to-wean patients on mechanical ventilation in MICU.Some underlying diseases had statistical significance in both groups,including AECOPD (x2 =6.238,P =0.028 ),idiopathic pulmonary fibrosis ( x2 =5.232,P =0.025 ) and neuromuscular disease ( x2 =14.635,P =0.007 ).The ratios of difficult-to-wean patients were 9/27,2/6 and 6/8 respectively.There was statistical significance of pre-admission and pre-weaning oxygenation index between two groups (t =2.183,2.162,P ＜ 0.05 ).Zubrod score at pre-weaning was also significantly different between two groups ( t =9.037,P ＜0.05).Logistic regression indicated that the patients with severe heart failure (OR =5.781 ),psychological disorders ( OR =4.654 ),obstructive sleep apnea ( OR =4.012 ),AECOPD ( OR =3.617 )and neuromuscular diseases ( OR =2.885) were more vulnerable to weaning difficulties.Conclusion The major risk factors of difficult-to-wean patients in MICU include severe heart failure,psychological diseases,obstructive sleep apnea,neuromuscular disease and AECOPD.And oxygenation and self-care capability may also affect weaning significantly.