Outcome and Predictors of Prolonged Mechanical Ventilation in Patients with Heart Failure

長期使用呼吸器的心臟衰竭患者預後及預測因子分析

黃鴻育(Hung-Yu Huang) ； 李立夫(Li-Fu Li) ； 李忠恕(Chung-Shu Lee) ； 張啟仁(Chee-Jen Chang) ； 陳濘宏(Ning-Hung Chen)

《胸腔醫學》 31卷6期 (2016/12) Pp. 311-322

摘要

前言：心臟衰竭是長期使用呼吸器的常見因素之一。我們針對心臟衰竭患者進行研究，統計脫離呼吸器的成功率以及分析脫離成功的相關因子。方法：在此回顧觀察性研究，收入2011 至2013 年在呼吸照護中心長期用呼吸器的心臟衰竭患者。主要指標是呼吸器脫離成功率。結果：研究期間共117 例心臟衰竭患者與634 例其他患者入住呼吸照護中心。心衰組有較低的呼吸器脫離成功率和較高的住院死亡率。在心衰組中，左心室收縮分率和B 型鈉尿肽類在呼吸器脫離成功與失敗的人中數值相近，成功脫離呼吸器的心衰竭患者表現出較高的昏迷指數（GCS）評分、較少接受血液透析，具有較高的血清白蛋白值，以及較少接受冠狀動脈繞道手術。多變數分析顯示預測呼吸器脫離成功最關鍵的因子是較高的昏迷指數。其他臨床上重要的預測因子包括白蛋白值、減少血液透析。在心臟衰竭組中，成功脫離呼吸器的患者有較低的死亡率。結論：心臟衰竭患者與其他長期使用呼吸器的患者比較起來表現出較低的呼吸器脫離成功率和較高的死亡率。在心臟衰竭患者中，意識分數較高、沒有血液透析，和沒有接受過冠狀動脈繞道手術史者更容易脫離機械通氣。

關鍵字

心臟衰竭 ； 長期呼吸器使用 ； 呼吸器脫離成果

並列摘要

Introduction: Cardiac dysfunction is 1 of several common factors related to prolonged mechanical ventilation (PMV). We investigated the weaning success rate of patients with heart failure (HF), who received PMV and the factors associated with weaning success in these patients. Methods: This was a retrospective observational study on patients with HF who received PMV in a 24-bed respiratory care center (RCC) between January 2011 and December 2013. The main outcome was weaning success, which was defined as more than 7 days entirely free from mechanical ventilator support. Results: In total, 117 patients with HF and 634 patients without HF treated in the RCC during the study period were included. The HF group had a significantly lower rate of weaning success (40.2% vs. 51.7%, P＜0.05) and a higher rate of in-hospital mortality (46.2% vs. 37.5%, P=0.11). In the HF group, the left ventricular ejection fraction and B-type natriuretic peptide were similar in patients with successful weaning and in those with unsuccessful weaning. The successfully-weaned patients with HF had a higher Glasgow coma scale (GCS) score, required less hemodialysis support, exhibited a high serum albumin level, and fewer of them having received a coronary artery bypass graft (CABG). Multivariable analysis revealed the most crucial predictor for weaning success was a high GCS score (P＜0.001). Other clinically important predictors were higher albumin level (P=0.047) and decreased hemodialysis support (P=0.047). The successfully-weaned patients in the HF group had a significantly lower in-hospital mortality rate (23.4% vs. 61.4%, P＜0.001). Conclusions: Patients with HF who received PMV had lower weaning and higher mortality rates than did patients without HF. Patients with HF who had an enhanced consciousness level, reduced hemodialysis use, and no history of receiving a CABG were more likely to be weaned from mechanical ventilation.

並列關鍵字

prolonged mechanical ventilation ； heart failure ； weaning outcome