广州医科大学学报

目的：探讨有创机械通气治疗慢性阻塞性肺疾病急性加重（AECOPD）合并呼吸衰竭患者发生撤机失败的影响因素。方法：回顾性分析2021年1月至2023年12月本院收治的AECOPD合并呼吸衰竭患者122例的临床资料，所有患者均行有创机械通气治疗。按治疗后撤机情况分为撤机顺利组与撤机失败组，分析撤机失败的影响因素。结果：共纳入有创机械通气治疗AECOPD合并呼吸衰竭患者122例，其中撤机顺利95例（77.87%），撤机失败27例（22.13%）。单因素分析显示，两组患者年龄、体质量指数（BMI）、糖尿病、插管前血红蛋白（Hb）、拔管时Hb、拔管时白细胞计数（WBC）、拔管时中性粒细胞分数（NEU%）、拔管时C反应蛋白（CRP）、拔管时白蛋白（ALB）水平组间比较，差异均有统计学意义（均P<0.05）；撤机顺利组多器官功能障碍综合征（MODS）及呼吸机相关性肺炎发生比例、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、机械通气时间均低于撤机失败组（均P<0.05）。多因素Logistic回归分析显示，患者年龄、BMI、糖尿病、插管前Hb、拔管时Hb、拔管时NEU%、拔管时ALB水平及MODS、APACHEⅡ评分、机械通气时间等因素为有创机械通气治疗AECOPD合并呼吸衰竭患者撤机失败的危险因素（均P<0.05）。结论：有创机械通气治疗AECOPD合并呼吸衰竭患者撤机失败的影响因素复杂多样，应明确危险因素，采取针对性治疗措施降低撤机失败发生率，改善预后。

Objective:To investigate the influencing factors of weaning failure in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure treated with invasive mechanical ventilation.Methods:The clinical data of 122 patients with AECOPD complicated with respiratory failure admitted to our hospital from January 2021 to December 2023 were retrospectively analyzed,and all the patients were treated with invasive mechanical ventilation. According to the weaning situation after treatment,the patients were divided into the successful weaning group and the failure weaning group,and the influencing factors of weaning failure were analyzed.Results:A total of 122 patients with AECOPD and respiratory failure treated with invasive mechanical ventilation were included,including 95 cases(77.87%)of successful weaning and 27 cases(22.13%)of failed weaning. Univariate analysis showed that there were significant differences in age,body mass index(BMI),diabetes,hemoglobin(Hb)before intubation,Hb at extubation,white blood cell count(WBC)at extubation,neutrophil fraction(NEU%)at extubation,C-reactive protein(CRP)at extubation,and albumin(ALB)at extubation between the two groups(all P<0.05);and the incidence of multiple organ dysfunction syndrome(MODS) and ventilator-associated pneumonia,acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score,and mechanical ventilation time in the successful weaning group were lower than those in the failure weaning group(all P<0.05). Multivariate logistic regression analysis showed that age,BMI,diabetes,Hb before intubation,Hb at extubation,NEU% at extubation,ALB level at extubation,MODS,APACHE Ⅱ score,and mechanical ventilation time were risk factors for weaning failure in patients with AECOPD and respiratory failure treated with invasive mechanical ventilation(all P<0.05).Conclusion:The influencing factors of weaning failure in AECOPD patients with respiratory failure treated by invasive mechanical ventilation are complex and diverse. Risk factors should be identified,and targeted treatment measures should be taken to reduce the incidence of weaning failure and improve the prognosis.