CAJ | 학술논문

目的：对行机械通气的老年患者进行随访观察，分析机械通气的短期预后及危险因素。方法选择2008年1月至2013年6月就诊于解放军总医院老年病房的270例机械通气患者为研究对象，根据机械通气后28d时和29d至3个月时患者的生存情况，将患者资料分成死亡组（n＝126）和存活组（n＝144）进行分析，采用单因素分析筛查出影响预后的因素，以有统计学意义的因素作为自变量进行多因素logistic回归分析，判断各因素对死亡风险的影响。结果270例老年机械通气患者，年龄（89.0±4.8）岁。肺炎（70.7%）为最常见病因，其次为急性左心衰（10.7%）和慢性阻塞性肺疾病急性加重（AECOPD，7.8%）等。28d内死亡86例（31.9%），3个月内共死亡126例（46.7%）。多因素logistic回归分析显示低氧合指数（PO2/FiO2）、前白蛋白降低、血尿素氮（BUN）增高、血清肌酐（SCr）增高（>165.2μmol/L）、使用呼气末正压（PEEP）是影响机械通气患者28d预后的危险因素（均P＜0.05）；慢性肾脏病（CKD）、C-反应蛋白（CRP）是影响机械通气患者29d至3个月时预后的危险因素（均P＜0.05）。结论肺炎、急性左心衰、AECOPD等是老年患者机械通气最常见的原因；CKD、低PO2/FiO2、前白蛋白降低、CRP、BUN增高、SCr增高（＞165.2μmol/L）及使用PEEP是影响机械通气患者预后的危险因素。
목적：대행궤계통기적노년환자진행수방관찰，분석궤계통기적단기예후급위험인소。방법선택2008년1월지2013년6월취진우해방군총의원노년병방적270례궤계통기환자위연구대상，근거궤계통기후28d시화29d지3개월시환자적생존정황，장환자자료분성사망조（n＝126）화존활조（n＝144）진행분석，채용단인소분석사사출영향예후적인소，이유통계학의의적인소작위자변량진행다인소logistic회귀분석，판단각인소대사망풍험적영향。결과270례노년궤계통기환자，년령（89.0±4.8）세。폐염（70.7%）위최상견병인，기차위급성좌심쇠（10.7%）화만성조새성폐질병급성가중（AECOPD，7.8%）등。28d내사망86례（31.9%），3개월내공사망126례（46.7%）。다인소logistic회귀분석현시저양합지수（PO2/FiO2）、전백단백강저、혈뇨소담（BUN）증고、혈청기항（SCr）증고（>165.2μmol/L）、사용호기말정압（PEEP）시영향궤계통기환자28d예후적위험인소（균P＜0.05）；만성신장병（CKD）、C-반응단백（CRP）시영향궤계통기환자29d지3개월시예후적위험인소（균P＜0.05）。결론폐염、급성좌심쇠、AECOPD등시노년환자궤계통기최상견적원인；CKD、저PO2/FiO2、전백단백강저、CRP、BUN증고、SCr증고（＞165.2μmol/L）급사용PEEP시영향궤계통기환자예후적위험인소。
Objective To investigate the risk factors and short-term outcome in very old patients undergoing mechanical ventilation. Methods A total of 270 very old patients undergoing mechanical ventilation in geriatric departments of Chinese PLA General Hospital from January 2008 to June 2013 were enrolled in this study. All the patients were divided into death group (n=126) and survival group (n=144) according to their outcomes in 28d, and from 29d to 3 months after mechanical ventilation. Univariate analysis was used to explore the related factors for prognosis from clinical data. Multivariate logistic regression analysis was carried out to determine the risk factors for death in these patients after mechanical ventilation. Results The cohort of patients was at the age of (89.0±4.8) years. Pneumonia (70.7%) was the major cause of mechanical ventilation. The other causes were acute heart failure (10.7%) and chronic obstructive pulmonary disease with acute exacerbation (AECOPD, 7.8%). There were 86 cases (31.9%) died within 28d after mechanical ventilation, and 126 cases (46.7%) died within 3 months. Multivariate logistic regression analysis revealed that low oxygenation index (PO2/FiO2), low serum pre-albumin, increased blood urea nitrogen (BUN), high serum creatinine (SCr>165.2μmol/L), and using positive end-expiratory pressure (PEEP) were the prognostic factors in those patients who died within 28d after mechanical ventilation (all P<0.05). Chronic kidney disease (CKD) and the level of C-reactive protein (CRP) were the prognostic factors in those patients died from 29d to 3 months after mechanical ventilation (P<0.05). Conclusion Pneumonia, acute heart failure and AECOPD are common causes of mechanical ventilation in elderly patients. CKD, low PO2/FiO2, low serum pre-albumin, CRP, increased BUN, high Scr (>165.2μmol/L) and using PEEP are the prognostic factors in the elderly patients with mechanical ventilation.