创伤后非心脏手术重症患者脱机失败的危险因素分析

赵连泽; 张超峰; 陈琦; 钮宏文; 祝涛

doi:10.16016/j.2097-0927.202112167

您当前的位置：

首页 >

文章列表页 >

创伤后非心脏手术重症患者脱机失败的危险因素分析

临床医学 | 更新时间：2026-01-09

- 创伤后非心脏手术重症患者脱机失败的危险因素分析
- Risk factors for weaning failure in critical trauma patients with non-cardiac surgery
- 陆军军医大学学报 2022年44卷第16期页码：1661-1665
- 作者机构：
  
  201203 上海，上海中医药大学附属曙光医院创伤急救科
- 作者简介：
  
  [祝涛，E-mail: zhutao7610@163.comZHU Tao, E-mail: zhutao7610@163.com
- 基金信息：
- DOI：10.16016/j.2097-0927.202112167
  中图分类号： R181.32;R605.973;R641
- 收稿：2021-12-22，
  
  修回：2022-03-02，
  
  纸质出版：2022-08-30
- 稿件说明：
移动端阅览
赵连泽, 张超峰, 陈琦, 等. 创伤后非心脏手术重症患者脱机失败的危险因素分析[J]. 陆军军医大学学报, 2022,44(16):1661-1665.

Lianze ZHAO, Chaofeng ZHANG, Qi CHEN, et al. Risk factors for weaning failure in critical trauma patients with non-cardiac surgery[J]. Journal of Army Medical University, 2022, 44(16): 1661-1665.
赵连泽, 张超峰, 陈琦, 等. 创伤后非心脏手术重症患者脱机失败的危险因素分析[J]. 陆军军医大学学报, 2022,44(16):1661-1665. DOI： 10.16016/j.2097-0927.202112167.

Lianze ZHAO, Chaofeng ZHANG, Qi CHEN, et al. Risk factors for weaning failure in critical trauma patients with non-cardiac surgery[J]. Journal of Army Medical University, 2022, 44(16): 1661-1665. DOI： 10.16016/j.2097-0927.202112167.

摘要

目的

分析创伤后非心脏手术重症患者脱离机械通气(脱机)失败的危险因素。

方法

选取2019年1月至2020年12月上海中医药大学附属曙光医院创伤急救科ICU病房收治的306例创伤后行非心脏手术且术后机械通气时间超过24 h的患者作为研究对象，回顾性分析入选患者的临床基线特征、化验结果、术中和术后资料，根据脱机结果将患者分为脱机成功组(

=222)与脱机失败组(

=84)。利用多元Logistic回归分析影响创伤后非心脏手术重症患者脱机失败的危险因素。

结果

纳入的306例患者中84名(27.4%)患者脱机失败。经单因素分析剔除混杂因素后，经过多元Logistic回归分析发现，年龄(

=1.835

95%

: 1.623~2.012

=0.002)、呼吸频率(

=1.860

95%

: 1.702~ 1.943

=0.001)、脑钠肽(brain natriuretic peptide，BNP)变化率(入ICU 24 h内BNP变化，

=3.366

95%

: 1.063~7.887

=0.000)、发生非心脏术后心肌损伤(

=4.237

95%

: 1.023~16.914

=0.001)是创伤后非心脏手术重症患者脱机失败的独立危险因素。

结论

高龄、呼吸频率升高、BNP水平升高、发生非心脏手术后心肌损伤(myocardial injury after non-cardiac surgery

MINS)是创伤后非心脏手术重症患者脱机失败的独立危险因素。

Abstract

Objective

To analyze the risk factors of weaning failure in posttraumatic critical patients with non-cardiac surgery.

Methods

A total of 306 patients with non-cardiac surgery who had mechanical ventilation more than 24 h after surgery

from January 2019 to December 2020

were included in this study. The clinical baseline characteristics

laboratory results

intraoperative and postoperative data of enrolled patients were retrospectively analyzed. These patients were divided into two groups: weaning success group (

=222) and weaning failure group (

=84). Risk factors for weaning failure in posttraumatic critical patients with non- cardiac surgery were determined by multivariate logistic regression analysis.

Results

Offline failure occurred in 84 out of 306 (27.4%) patients. After elimination of confounding factors by univariate analysis

multivariate logistic regression analysis showed that age(

=1.835

95%

: 1.623~2.012

=0.002)

respiratory frequency(

=1.860

95%

: 1.702~1.943

=0.001)

change rate of BNP(

=3.366

95%

: 1.063~ 7.887

=0.000) and myocardial injury after non-cardiac surgery(

=4.237

95%

: 1.023~16.914

=0.001) were the independent risk factors of weaning failure in post-traumatic critical patients with non-cardiac surgery.

Conclusion

Age

respiratory frequency

myocardial injury after non-cardiac surgery (MINS)

and increased change rate of BNP are independent risk factors of weaning failure in post-traumatic critical patients with non-cardiac surgery.

关键词

Keywords

references

UVIZL R, HERKEL T, LANGOVA K, et al . Management of mechanical ventilation in patients with hospital-acquired pneumonia: a retrospective, observational study[J ] . Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2018, 162(2): 127-133. DOI: 10.5507/bp.2017.047.

PERKINSG D, MISTRY D, GATES S, et al . Effect of protocolized weaning with early extubation to noninvas ventilation vs invasive weaning on time to liberation from mechanical ventilation among patients with respiratory failure: the breathe randomized clinical trial[J ] . JAMA, 2018, 320(18): 1881-1888. DOI: 10.1001/jama.2018.13763.

ROUTSI C, STANOPOULOSI, KOKKORIS S, et al . Weaning failure of cardiovascular origin: how to suspect, detect and treat-a review of the literature[J ] . Ann Intensive Care, 2019, 9(1): 6. DOI: 10.1186/s13613-019-0481-3.

MICA L, RUFIBACH K, KEEL M, et al . The risk of early mortality of polytrauma patients associated to ISS, NISS, APACHE Ⅱ values and prothrombin time[J ] . J Trauma Manag Outcomes, 2013(7): 6. DOI: 10.1186/1752-2897-7-6.

BOLESJ M, BION J, CONNORS A, et al . Weaning from mechanical ventilation[J ] . Eur Respir J, 2007, 29(5): 1033-1056. DOI: 10.1183/09031936.00010206.

BOTTO F, ALONSO-COELLO P, CHANM T V, et al . Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes[J ] . Anesthesiology, 2014, 120(3): 564-578. DOI: 10.1097/ALN.0000000000000113.

MAHMOOD S S, PINSKY M R. Heart-lung interactions during mechanical ventilation: the basics[J]. Ann Transl Med, 2018, 6(18): 349. DOI:10.21037/atm.2018.04.29.

SOUSA J, ROCHA-NEVES J, OLIVEIRA-PINTO J, et al . Myocardial injury after non-cardiac surgery (MINS) in EVAR patients: a retrospective single-centered study[J ] . J Cardiovasc Surg (Torino), 2021, 62(2): 130-135. DOI: 10.23736/S0021-9509.20.11205-9.

JORGENSONC C, COFFMAN K E, JOHNSON B D. Effects of intrathoracic pressure, inhalation time, and breath hold time on lung diffusing capacity[J]. Respir Physiol Neurobiol, 2018, 258: 69-75. DOI: 10.1016/j.resp.2018.06.001.

CHEYNEW S, GELINAS J C, EVES N D. The haemo dynamic response to incremental increases in negative intrathoracic pressure in healthy humans[J]. Exp Physiol, 2018, 103(4): 581-589. DOI: 10.1113/EP086654.

DUBO S, VALENZUELAE D, AQUEVEDO A, et al . Early rise in central venous pressure during a spontaneous breathing trial: a promising test to identify patients at high risk of weaning failure?[J ] . PLoS ONE, 2019, 14(12): e0225181. DOI: 10.1371/journal.pone.0225181.

SANCHEZ M L. Mechanical ventilation in patients subjected to extracorporeal membrane oxygenation (ECMO)[J]. Med Intensiva, 2017, 41(8): 491-496. DOI: 10.1016/j.medin.2016.12.007.

HAMMASHM H, MOSER D K, FRAZIER S K, et al . Heart rate variability as a predictor of cardiac dysrhythmias during weaning from mechanical ventilation[J ] . Am J Crit Care, 2015, 24(2): 118-127. DOI: 10.4037/ajcc2015318.

MUNSHI L, FERGUSONN D. Weaning from mechanical ventilation: what should be done when a patient's spontaneous breathing trial fails?[J]. JAMA, 2018, 320(18): 1865-1867. DOI: 10.1001/jama.2018.13762.

BEDET A, TOMBERLI F, PRAT G, et al . Myocardial ischemia during ventilator weaning: a prospective multicenter cohort study[J ] . Crit Care, 2019, 23(1): 321. DOI: 10.1186/s13054-019-2601-8.

李纾, 杜安琪, 赵连泽, 等. 心肌肌钙蛋白I水平对非心脏手术后心肌损伤患者脱离机械通气的预测价值[J]. 中国循环杂志, 2020, 35(2): 161-166. DOI: 10.3969/j.issn.1000-3614.2020.02.009.

LI S, DU A Q, ZHAO L Z, et al . Value of cardiac troponin I level on predicting weaning failure in patients with myocardial injury after non-cardiac surgery[J ] . Chin Circ J, 2020, 35(2): 161-166. DOI: 10.3969/j.issn.1000-3614.2020.02.009.

EDIBOǦLU Ö, KRAKL C. Can NT-pro BNP levels predict prognosis of patients with acute exacerbations of chronic obstructive pulmonary disease in the intensive care unit?[J]. Balkan Med J, 2018, 35(6): 422-426. DOI: 10.4274/balkanmedj.2018.0006.

ADRISH M, NANNAKAV B, CANO E J, et al . Significance of NT-pro-BNP in acute exacerbation of COPD patients without underlying left ventricular dysfunction[J ] . Int J Chron Obstruct Pulmon Dis, 2017, 12: 1183-1189. DOI: 10.2147/COPD.S134953.

FARGHALY S, GALAL M, HASANA A, et al . Brain natriuretic peptide as a predictor of weaning from mechanical ventilation in patients with respiratory illness[J ] . Aust Crit Care, 2015, 28(3): 116-121. DOI: 10.1016/j.aucc.2014.12.002.

SANTAGUIDAP L, DON-WAUCHOPE A C, OREMUS M, et al . BNP and NT-proBNP as prognostic markers in persons with acute decompensated heart failure: a systematic review[J ] . Heart Fail Rev, 2014, 19(4): 453-470. DOI: 10.1007/s10741-014-9442-y.

BORNITZ F, EWERT R, KNAAK C, et al . Weaning from invasive ventilation in specialist centers following primary weaning failure[J ] . Dtsch Arztebl Int, 2020, 117(12): 205-210. DOI: 10.3238/arztebl.2020.0205.

SANFILIPPO F, DI FALCO D, NOTO A, et al . Association of weaning failure from mechanical ventilation with transthoracic echocardiography parameters: a systematic review and meta-analysis[J ] . Br J Anaesth, 2021, 126(1): 319-330. DOI: 10.1016/j.bja.2020.07.059.

SOUZA LEITE W, NOVAES A, BANDEIRA M, et al . Patient-ventilator asynchrony in conventional ventilation modes during short-term mechanical ventilation after cardiac surgery: randomized clinical trial[J ] . Multidiscip Respir Med, 2020, 15(1): 650. DOI: 10.4081/mrm.2020.650.

HAN L, ZHANG S S, KANG J Q, et al . Predictive value of C-reactive protein and NT-pro-BNP levels in sepsis patients older than 75 years: a prospective, observational study[J ] . Aging Clin Exp Res, 2020, 32(3): 389-397. DOI: 10.1007/s40520-019-01244-0.

DESCHAMPS J, ANDERSENS K, WEBBER J, et al . Brain natriuretic peptide to predict successful liberation from mechanical ventilation in critically ill patients: a systematic review and meta-analysis[J ] . Crit Care, 2020, 24(1): 213. DOI: 10.1186/s13054-020-2823-9.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

ICU创伤后感染患者并发脓毒症的危险因素分析

复方营养制剂干预对心血管外科手术患者临床预后影响的随机对照研究

急性前循环大血管闭塞性卒中患者血管内治疗后发生卒中相关性肺炎的危险因素分析

核仁磷酸蛋白1突变的分子异质性对急性髓系白血病预后的影响

非肌层浸润性膀胱癌二次电切术后疗效评估及预后影响因素分析