老年长期机械通气患者的预后影响因素

Analysis of prognosis factors in elderly patients requiring long-term mechanical ventilation

关键词:  机械通气  呼吸衰竭  预后

Key words:  mechanical ventilation  respiratory failure  prognosis

摘要:

探讨长期老年机械通气（≥7d）患者的预后影响因素。［方法］回顾性调查 2001年4月～2003年10月老年长期机械通气患者，对入院时生命体征、辅助检查以及急性生理与慢性健康评分（APACHEⅡ）等指标进行调查，并对各项指标进行Logistic回归分析。［结果］31例（59.6%）患者死亡，21例患者（40.4%）生存。生存组的中心静脉压（CVP）、白蛋白水平（ALB）等理化指标以及APACHEⅡ评分显著优于死亡组（P<0.05），同时生存组中气管切开的比例较高（P<0.05）。Logistic回归显示ALB （P=0.01；OR值 0.77；95% 可信区间：0.67～0.87）对LTMV的预后有积极影响。［结论］ 老年长期机械通气患者的院内死亡率较高，血清白蛋白水平和气管切开是主要的预后决定因素，在机械通气前应该对上述影响因素进行充分评估。

Abstract:

To investigate prognostic factors in elderly patients receiving long-term mechanical ventilation. ［Methods］ Retrospective study were made in 52 elderly patients receiving ≥7 days of mechanical ventilation from April 2001 to October 2003. Admitting clinical and physiological parameters were analyzed by Logistic regression methods. ［Results］ Of the patients enrolled in the study, 31 cases(59.6%)died in the hospital and 21 (40.4%)were survival. Differences in central venous pressure (CVP), level of plasma albumin and Acute Physiology and Chronic Health Evaluation (APACHE II) score between survivors and nonsurvivors were significant (P<0.05). Performing tracheotomy were also significantly difference between two groups (P<0.05). With multiple logistic regressions, higher ALB level (P=0.01; OR 0.77; 95% confidence interval: 0.67～0.87) were independent predictors of benignantly outcome. ［Conclusions］ elderly LTMV patients should be considered in higher risk for death. Serum albumin level and undergoing tracheotomy were major prognosis factors; these relevant characteristics should be evaluated before mechanical ventilation