摘要
目的探讨接受机械通气的重症肿瘤患者再插管危险因素和预后。方法选择2013年6月至2015年1月于中国医学科学院肿瘤医院重症监护病房(ICU)收治的机械通气时间超过48 h后,择期拔管的重症肿瘤患者为研究对象。根据重症肿瘤患者择期拔管后是否需再次气管插管进行机械通气治疗,将其分别纳入再插管组(n=16)与无需再插管组(n=64)。采用回顾性分析法,收集80例受试者的基本临床资料及择期拔管48 h后再插管率,并对重症肿瘤患者再插管危险因素进行单因素分析与多因素非条件logistic回归分析。结果 (1)本研究80例受试者中,择期拔管48 h后再插管率为20%(16/80)。2组患者的年龄、性别构成比、人体质量指数(BMI)及原发肿瘤部位构成比等一般临床资料比较,差异均无统计学意义(P>0.05)。(2)重症肿瘤患者再插管危险因素的单因素分析结果显示,与无需再插管组患者相比,再插管组患者年龄调整的Charlson评分显著增高,分别为(2.9±1.4)分与(3.7±1.4)分,二者比较,差异有统计学意义(t=2.300,P=0.024)。再插管组重症肿瘤患者拔管前自主呼吸试验(SBT)次数,亦显著多于无需再插管组,分别为(1.7±1.6)次与(2.9±2.4)次,二者比较,差异亦有统计学意义(t=2.409,P=0.018)。(3)多因素非条件logistic回归分析结果显示,年龄调整的Charlson评分是重症肿瘤患者再插管的独立危险因素(OR=1.583,95%CI:1.084~2.312,P=0.017)。(4)再插管组患者总机械通气时间,较无需再插管组延长,分别为(7.0±6.1)d与(19.9±20.1)d,二者比较,差异亦有统计学意义(t=27.752,P<0.001)。与无需再插管组患者相比,再插管组患者ICU住院时间更长,分别为(10.0±8.3)d与(24.2±18.2)d,二者比较,差异有统计学意义(t=11.608,P<0.001)。2组重症肿瘤患者ICU病死率、住院病死率和住院时间分别比较,差异均无统计学意义(P>0.05)。结论年龄调整的Charlson评分,是重症肿瘤患者再插管的�
Objective To determine the risk factors and prognosis of reintubation in critically mechanical ventilation patients with cancer. Methods Patients who received mechanical ventilation longer than 48 h in Intensive Care Unit (ICU) from June 2013 to January 2015 were enrolled in analyses. Patients were divided into 2 groups: reintubation group (n=16) and non-reintubation group (n=64) according to whether patients were reintubated after planned extubation. Basic clinical data of patients were retrospectively collected and reviewed. Univariate and multivariable logistic regression analysis were used to determine the risk factors of reintubation. Results (1)Among all of the 80 patients, 16 (20%) patients were re-intubated after extubation. There were no significant differences between two groups in the age, gender, body massindex (BMI) and constituent ratio of primary tumor sites etc (P 〉 0.05). (2) Univariate analysis showed that compared with patients in non-reintubation group, patients in reintubation group were associated with higher age-adjusted Charlson score (3.7± 1.4 vs 2.9± 1.4, t=2.300, P=0.024), more spontaneous breathing trials, (2.9±2.4 vs. 1.7±1.6, t=2.409, P=0.018). (3) Multi-variable analysis demonstrated that age-adjusted Charlson score was the only risk factor of reintubation in critically ill patients with cancer (OR=1.583, 95%CI: 1.084-2.312; P=0.017). (4) Compared with patients in non-reintubation group, patients in reintubation group were associated with longer duration of ventilation (19.9 ± 20.1 vs 7.0± 6.1, t=27.752, P 〈 0.001) and longer ICU length of stay (24.2 ± 18.2 vs 10.0 ±8.3, t= 11.608, P 〈 0.001). However, there were no significant differences between two groups in ICU and hospital mortality and hospital length of stay (P 〉 0.05). Conclusions Age-adjusted Charlson score is the risk factor of reintubation in critically ill patients with cancer. Reintubation is associated with longer ICU length of stay and
出处
《中华重症医学电子杂志》
2017年第3期191-196,共6页
Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)