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目的:探讨呼吸重症监护病房的慢性阻塞性肺病(COPD)患者机械通气时间分别大于7,14,21d的潜在危险因素。方法:前瞻性记录和回顾性分析患者在疾病稳定期,入住呼吸重症监护病房时及在呼吸重症监护病房期间的特征。以t检验,χ2检验和逻辑回归分析作为统计学方法。结果:63例COPD需要机械通气患者入选。其中26例患者机械通气时间小于7d,机械通气时间大于7,14,21d的患者分别为20例,8例和9例。机械通气持续时间与社区获得性肺炎,入住时基础肺功能实验结果和血气分析均无明显相关性。发生呼吸机相关性肺炎(OR:5.8;95%,CI:2-22,P=0.013)作为机械通气大于7d的独立预测因子;呼吸机相关性肺炎也是机械通气大于14d(OR:15;95%,CI:4-70,P=0.001)的危险因素;机械通气大于21d主要与入住呼吸重症监护病房时急性生理与慢性健康Ⅱ评分(OR:1.7;95%,CI:1-1.5,P=0.002)和白蛋白水平(OR:0.5,95%CI:0.27-0.61,P=0.006)相关。结论:入住时病情严重程度和入住呼吸重症监护病房后发生呼吸机相关性肺炎是COPD患者的机械通气持续时间的主要决定因素。
Objective: To investigate the potential risk factors of mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD) of respiratory intensive care unit which were greater than 7, 14 and 21 days respectively. METHODS: Prospective records and retrospective analyzes of patients during stable disease, admission to the intensive care unit and during the intensive care unit were performed. T test, χ2 test and logistic regression analysis were used as statistical methods. Results: Sixty-three COPD patients were enrolled for mechanical ventilation. Among them, 26 patients had mechanical ventilation for less than 7 days, 20 cases for mechanical ventilation more than 7,14,21 days, 8 cases and 9 cases for mechanical ventilation. The duration of mechanical ventilation did not correlate well with community-acquired pneumonia, baseline lung function test results, and blood gas analysis at admission. Ventilator-associated pneumonia (OR: 5.8; 95%; CI: 2-22, P = 0.013) was an independent predictor of ventilator-associated pneumonia over 7 days; ventilator-associated pneumonia was also associated with mechanical ventilation greater than 14 days %, CI: 4-70, P = 0.001). The scores of Acute Physiology and Chronic Health Ⅱ (OR: 1.7; 95%, CI: 1-1.5, P = 0.002) and albumin levels (OR: 0.5, 95% CI: 0.27-0.61, P = 0.006). CONCLUSION: Ventilator-associated pneumonia occurs on the severity of illness at admission and after admission to the respiratory intensive care unit and is the major determinant of the duration of mechanical ventilation in COPD patients.