日常生活能力量表对AECOPD患者机械通气治疗结局的预测价值

高波; 王树云; 朱长清; 陆晓晔; 徐欣晖

doi:10.13201/j.issn.1009-5918.2017.06.012

日常生活能力量表对AECOPD患者机械通气治疗结局的预测价值

- 1. 上海交通大学医学院附属仁济医院急诊科(上海, 200127);
- 2. 复旦大学附属浦东医院重症医学科
基金项目:
上海市科学技术委员会科研计划项目 (No:15DZ1941307)

详细信息

通讯作者: 陆晓晔, E-mail:luxiaoye@renji.com

中图分类号: R563

收稿日期: 2017-04-25

Predictive value of ADL score in AECOPD patients requiring invasive mechanical ventilation

- 1 Department of Emergency Intensive Care Unit, Renji Hospital, Shanghai Jiaotong University, Shanghai 200127, China;
- 2 Department of Critical Care Medicine, Fudan University Pudong Medical Center

More Information

Corresponding author: LU Xiaoye, E-mail: luxiaoye@renji.com

Received Date: 25 April 2017

摘要

摘要: 目的: 对于慢性阻塞性肺疾病急性加重(AECOPD)伴呼吸衰竭接受有创呼吸支持治疗的患者,目前临床上尚缺乏有效可行的生活质量评分系统来预测撤机结果。本研究尝试采用非特异的日常生活能力(ADL)评定量表Barthel指数来预测此类患者的治疗转归。方法: 前瞻性分析25例行有创机械通气的AECOPD患者,统计入院时的动脉血气分析、炎症指标、血糖、心衰指数、营养状况和APPACHEⅡ评分等指标以及患者近期稳定状态时ADL评分,根据撤机结果分为撤机成功组(12例)和撤机失败组(13例),统计2组各项指标的差异。再根据ADL评分,将25例患者分为ADL>60分组(13例)和ADL ≤ 60分组(12例),比较2组撤机成功率和6个月病死率。结果: 撤机成功组与撤机失败组间仅ADL评分差异有统计学意义(93.46±5.16 vs.52.08±16.71,P=0.022),其余各项指标差异均无统计学意义。ADL>60分组和ADL ≤ 60分组的撤机成功率比较差异有统计学意义(84.6% vs.8.3%,P<0.0001),6个月病死率比较差异有统计学意义(23.1% vs.100.0%,P<0.0001)。结论: 本次预实验的研究结果表明ADL评分对AECOPD机械通气的治疗结局有较好的预测价值。
- 慢性阻塞性肺疾病急性加重 /
- 急性呼吸衰竭 /
- 有创机械通气 /
- 日常生活能力评分
Abstract: Objective: There is limited effective and feasible life quality assessment systems available to predict the outcomes of patients with AECOPD suffering from acute respiratory failure (ARF) accepted invasive mechanical ventilation(MV).This study attempted to use the activities daily living (ADL) score to predict the outcome of this kind of patients.Method: A total of 25 AECOPD patients with ARF admitted to intensive care unit (ICU) were enrolled in this prospectively study.They were divided into successful weaning group (12 patients) and unsuccessful weaning group (13 patients).On admission of their hospitalization,the clinical information including arterial blood gases,nutritional status,inflammatory biomarkers,blood glucoses,BNP,ADL scores,and APPACHE Ⅱ scores were collected and analyzed.According to the ADL score,the patients were divided into ADL score>60 group (13 patients) and ADL score ≤ 60 group (12 patients).The success rate of weaning and the mortality at the 6th month were investigated.Result: The ADL score was higher in successful weaning group than that in unsuccessful weaning group(93.46±5.16 vs.52.08±16.71,P=0.022).Weaning was achieved in 84.6% of the cases with an ADL score>60 and in 8.3% of the cases with an ADL score ≤ 60(P<0.0001).Arterial blood gases,inflammatory biomarkers,BNP and nutritional status were similar in both groups.The mortality at the sixth month was 23.1% in the cases with an ADL score>60 and was 100% in the cases with an ADL score ≤ 60(P<0.0001).Conclusion: Our pilot study indicated that the ADL score may predict weaning and 6 month survival in AECOPD patients with ARF accepted invasive MV treatment.
- AECOPD /
- acute respiratory failure /
- mechanical ventilation weaning /
- Activities of Daily Living score

HTML全文

参考文献(11)

[1]	Brochard L, Mancebo J, Wysocki M, et al.Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonay disease[J].N Engl J Med, 1995, 333 (13):817-822.
[2]	Bott J, Carroll M P, Conway J H, et al.Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease[J].Lancet, 1993, 341 (8860):1555-1557.
[3]	Kramer N, Meyer T J, Meharg J, et al.Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure[J].Am J Respir Crit Care Med, 1995, 151 (6):1799-1806.
[4]	Celikel T, Sungur M, Ceyhan B, et al.Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure[J].Chest, 1998, 114 (6):1636-1642.
[5]	Plant P K, Owen J L, Elliott M W.Early use of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards:a multicentre randomized controlled trial[J].Lancet, 2000, 355 (9219):1931-1935.
[6]	陆志华, 徐秋萍, 袁月华, 等.膈肌增厚分数指导慢性阻塞性肺疾病机械通气患者撤机的临床研究[J].中华急诊医学杂志, 2016, 25 (4):491-494.
[7]	刘火根, 刘玲, 汤睿, 等.评价膈肌功能指导慢性阻塞性肺疾病患者撤机的可行性研究[J].中华内科杂志, 2011, 50 (6):459-464.
[8]	Menzies R, Gibbons W, Goldberg P.Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure[J].Chest, 1989, 95 (2):398-405.
[9]	Nava S, Rubini F, Zanotti E, et al.Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21days[J].Eur Respir J, 1994, 7 (9):1645-1652.
[10]	Monjazebi F, Dalvandi A, Ebadi A, et al.Functional status assessment of COPD based on ability to perform daily living activities:a systematic review of paper and pencil instruments[J].Glob J Health Sci, 2016, 8 (3):210-223.
[11]	Langlet K, Van Der Linden T, Claire Launois, et al.Predictive value of daily living score in acute respiratory failure of COPD patients requiring invasive mechanical ventilation pilot study[J].BMC Pulm Med, 2012, 12:66.