【摘要】 目的统计分析造成呼吸机撤机失败的各种因素。方法对我院及华西医院呼吸内科统计分析影响撤机成败的独立风险因素。结果回归分析提示:机械通气时间、基础肺部疾病、近期肺部感染,APACHEⅡ、血浆白蛋白、电解质紊乱、咳嗽排痰能力7项指标为影响撤机成败的独立危险因素。随着机械通气时间的延长,成功撤机的概率不断下降;有咳嗽排痰能力的患者撤机成功的概率远高于没有咳嗽排痰能力的患者。撤机成败的肺外因素主要有电解质紊乱和血浆白蛋白水平。无电解质紊乱者撤机成功概率是有电解质紊乱者的20.7倍。血浆白蛋白水平正常患者的脱机成功概率远高于血浆白蛋白水平低于正常者,是后者的40倍。结论本研究提示机械通气时间等7项指标为影响撤机失败的独立危险因素。肺外因素也一样决定着撤机的成败,其中营养状态和电解质水平是易于被忽视的两个重要参数。更多还原

【Abstract】 Objective To analyze risk factors of ventilator dependent patients and suggest feasible countermeasures for discontinuing mechanical ventilation.Methods A retrospective clinical study in 183 patients with mechanical ventilation was carried out in department of respiratory of our hospital and Huaxi hospital.The time range and clinical data and other possible causes of difficult weaning were collected and analyzed by logistic regression.Results Our study suggest,in the discontinuing of ventilation,duration of ventilation,basic lung disease,recent lung infection,apacheⅡscore,plasma-albumin level,electrolyte disturbances,and the ability to cough or clear sputum were independent influential factors which influenced the success of weaning.Conclusion Weaning of mechanical ventilation is a complicated and systematic procedure.The management of optimal time and general condition during withdrawing,the mechanical ventilation are important for the ventilator dependent Patients.In the multi-variable logistic regression analysis,ventilation time,basic lung disease,recent lung infection,apacheⅡscore,plasma-albumin level,plasma-albumin level,electrolyte disturbances,and the ability to cough or clear Sputum are independent factors which influence the success of weaning.Among all these factors,plasma-albumin level and electrolyte disturbances are both most important but easily be neglected factors besides in-lung cause.Ignoring these factors will lead to failure of discontinuing of mechanical ventilat.更多还原