CAJ | 학술논문

目的分析影响有创呼吸机治疗慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭患者撤机失败的危险因素。方法以2011年3月至2012年3月入住我院重症医学科的COPD并Ⅱ型呼吸衰竭需有创机械通气治疗的患者共67例为研究对象，采用低水平压力支持模式进行撤机，根据撤机结果分为撤机成功组和撤机失败组，记录所有患者一般情况，评估重要脏器功能，记录动脉血气、呼吸频率、潮气量、白细胞计数、肝肾功能、血浆白蛋白水平、胃肠功能、心脏功能、凝血四项、D二聚体等临床指标，计算浅快呼吸指数。结果撤机失败组13例，与撤机成功组比较，撤机失败组中APACHⅡ评分高，病程长，浅快呼吸指数高，纤维蛋白原水平高，胃肠功能受损、心功能不全和高脂血症的发生率均明显高于撤机成功组（ P＜0.05）；而血清白蛋白水平明显低于撤机成功组（ P＜0.05）。 Logistic多元回归分析结果显示呼吸浅快指数大、胃肠功能受损、低白蛋白血症、心功能不全是COPD合并Ⅱ型呼吸衰竭患者撤机失败的独立危险因素。结论 APACHⅡ评分高、病程长、浅快呼吸指数高、纤维蛋白原水平高、胃肠功能受损、心功能不全和高脂血症是CODP合并Ⅱ型呼吸衰竭患者撤机失败的危险因素；而浅快呼吸指数高、胃肠功能受损、低白蛋白血症及心功能不全是COPD合并Ⅱ型呼吸衰竭患者撤机失败的独立危险因素。
목적분석영향유창호흡궤치료만성조새성폐질병（COPD）합병Ⅱ형호흡쇠갈환자철궤실패적위험인소。방법이2011년3월지2012년3월입주아원중증의학과적COPD병Ⅱ형호흡쇠갈수유창궤계통기치료적환자공67례위연구대상，채용저수평압력지지모식진행철궤，근거철궤결과분위철궤성공조화철궤실패조，기록소유환자일반정황，평고중요장기공능，기록동맥혈기、호흡빈솔、조기량、백세포계수、간신공능、혈장백단백수평、위장공능、심장공능、응혈사항、D이취체등림상지표，계산천쾌호흡지수。결과철궤실패조13례，여철궤성공조비교，철궤실패조중APACHⅡ평분고，병정장，천쾌호흡지수고，섬유단백원수평고，위장공능수손、심공능불전화고지혈증적발생솔균명현고우철궤성공조（ P＜0.05）；이혈청백단백수평명현저우철궤성공조（ P＜0.05）。 Logistic다원회귀분석결과현시호흡천쾌지수대、위장공능수손、저백단백혈증、심공능불전시COPD합병Ⅱ형호흡쇠갈환자철궤실패적독립위험인소。결론 APACHⅡ평분고、병정장、천쾌호흡지수고、섬유단백원수평고、위장공능수손、심공능불전화고지혈증시CODP합병Ⅱ형호흡쇠갈환자철궤실패적위험인소；이천쾌호흡지수고、위장공능수손、저백단백혈증급심공능불전시COPD합병Ⅱ형호흡쇠갈환자철궤실패적독립위험인소。
Objective To analyze the failure factors of weaning invasive ventilation from the patients with chronic obstructive pulmonary disease ( COPD) complicated with respiratory failure typeⅡ.Methods There were 67 patients with COPD complicated with respiratory failure typeⅡin intensive care unit from March 2011 to March 2012 in our hospital,they required the treatment of invasive mechanical ventilation ,accepted the weaning trial under low pressure support ventilation ,according to the weaning outcome they were divided into two subgroup ( successful group and failure group ) ,we recorded all patients′information in general ,assessed the function of vital organs ,and recorded the clinical indicators such as the arterial blood gases , white blood cell count , respiratory rate , tidal volume , liver function,blood plasma albumin level,gastrointestinal function,cardiac function,coagulation function,D-dimer,and calculated the rapid shallow breathing index .Results There were 13 patients in the failure group , compared with successful group,the APACHEⅡ score was higher,course of disease was longer,rapid shallow breathing index and fibrinogen were higher , the incidence of the impairment of gastrointestinal function , cardiac dysfunction and hyperlipidemia were significantly higher in the failure group ( P<0.05 );and albumin protein level was significantly lower than that in the successful group ( P<0.05 ) .The result of Logistic multiple regression analysis showed that the high lever of the rapid shallow breathing index , impairment of gastrointestinal function , hypoalbuminemia , cardiac dysfunction were the independent risk factors of the patients with COPD complicated with respiratory failure type Ⅱto fail weaning.Conclusions High APACHEⅡscore,long course of disease,high level of the rapid shallow breathing index ,high fibrinogen ,impairment of gastrointestinal function ,cardiac insufficiency and hyperlipidemia are the failure risk factors of the patients with COPD complicated with respiratory failure type Ⅱweaning from mechanical ventilation; while high level of the rapid shallow breathing index , impairment of gastrointestinal function , hypoalbuminemia and cardiac dysfunction are the independent risk factors of the patients with COPD complicated with respiratory failure typeⅡto fail weaning from invasive mechanical ventilation .