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目的:探讨左心功能不全对慢性阻塞性肺病急性加重(AECOPD)呼吸衰竭机械通气患者脱机困难的影响。方法:选取上海市松江区中心医院重症监护室(ICU)2012-01-2015-02期间55例AECOPD呼吸衰竭有创机械通气患者进行前瞻性队列研究,根据治疗1周后是否脱离呼吸机分为脱机组43例,未脱机组12例,以脉搏指示的连续心输出量监测技术(PiCCO)监测患者治疗前及治疗1周的血流动力学指标:血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI)、心排量指数(CI)、全心舒张末期容积指数(GEDVI)、心功能指数(CFI)、全心射血分数(GEF)、左心室收缩力指数(dP/dtmax)变化,对影响脱机相关因素进行Logistic多因素回归分析。结果:1脱机组治疗后与治疗前相比,EVLWI、GEDVI降低,CI、CFI、GEF、dP/dtmax升高,差异有统计学意义(P<0.05),PVPI在治疗前后差异无统计学意义;2未脱机组治疗后与治疗前相比EVLWI、PVPI、CI、GEDVI、CFI、GEF、dP/dtmax差异无统计学意义;3脱机组治疗后与未脱机组治疗后比较EVLWI、GEDVI更低,CI、CFI、GEF、dP/dtmax更高,差异有统计学意义(P<0.05);4经多因素Logistic回归分析显示治疗后EVLWI、CFI、GEF是AECOPD有创机械通气患者1周脱机困难的独立危险因素。结论:左心功能不全及伴随的肺水肿是影响AECOPD机械通气患者脱机困难的一个重要原因,PICCO技术提供的EVLWI、CFI、GEF治疗后指标可监测此类患者的左心功能状态并预测困难脱机,对AECOPD呼吸衰竭患者机械通气治疗有指导意义。
Objective: To investigate the effect of left ventricular dysfunction on the off-line difficulty in patients with mechanical ventilation of respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: A prospective cohort study was conducted in 55 patients with AECOPD respiratory failure invasive mechanical ventilation during intensive care unit (ICU) of Shanghai Songjiang Central Hospital between January 2012 and December 2015. According to whether they were separated from the ventilator after 1 week of treatment 43 patients in the off-line group and 12 patients in the off-line group were enrolled in this study. The hemodynamics of patients before and 1 week of treatment were monitored by pulse continuous cardiac output monitoring (PiCCO): extravascular lung water index (EVLWI) Pulmonary vascular permeability index (PVPI), cardiac output index (CI), global end-diastolic volume index (GEDVI), cardiac function index (CFI), total cardiac ejection fraction (GEF), left ventricular systolic index dP / dtmax), Logistic multivariate regression analysis was performed on the factors influencing off-line. Results: 1 After treatment, the levels of EVLWI, GEDVI, CI, CFI, GEF, dP / dtmax in the treatment group were significantly higher than those before treatment (P <0.05) Significance 2. There was no significant difference in EVLWI, PVPI, CI, GEDVI, CFI, GEF and dP / dtmax between the two groups before and after treatment; 3 EVLWI (P <0.05) .4 Multivariate Logistic regression analysis showed that EVLWI, CFI and GEF were the patients with AECOPD invasive mechanical ventilation after treatment 1 week independent risk factors for offline difficulty. CONCLUSIONS: Left ventricular dysfunction and concomitant pulmonary edema are important causes of offline dysfunction in patients with AECOPD mechanical ventilation. The post-treatment EVLWI, CFI, and GEF indicators provided by PICCO may monitor left ventricular function and predict difficulty in these patients Offline, AECOPD respiratory failure patients with mechanical ventilation therapy has instructive significance.