在COPD患者接受选择性手术时,手术内呼吸模式对发病率和死亡率的影响
Mariya M Shemetova1, Levan B Berikashvili1, Mikhail Ya Yadgarov1
1Department of Clinical Trials and Intelligent IT, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 25 Petrovka Str., 107031 Moscow, Russia.
术内通风设置没有显著影响经过手术的慢性阻塞性肺病 (COPD) 患者的结果. 然而,平原压力可能会影响中性粒细胞与淋巴细胞的比率,尽管原因尚不清楚.
科学领域:
- 关键护理医学 关键护理医学
- 肺部医学 肺部医学
- 外科手术的结果
背景情况:
- 患有慢性阻塞性肺病 (COPD) 的患者面临呼吸衰竭的风险增加,并且在手术后长期停留在重症监护室 (ICU).
- 在COPD患者中同时存在的心力衰竭进一步加剧了手术并发症的风险.
- 确定这些高风险手术患者不良结果的预测因素至关重要.
研究的目的:
- 确定死亡率的预测因素,长时间的重症监护室和住院,以及机械通风或血管活性药物的需要.
- 分析在重症监护病房 (ICU) 中接受选择性非心脏手术的中度至重度慢性阻塞性肺病 (COPD) 患者的结局.
主要方法:
- 使用eICU协作研究数据库 (eICU-CRD) 的回顾性队列研究.
- 包括接受心脏外科手术后接受ICU治疗的中度至重度COPD的成年患者.
- 斯皮尔曼的相关性分析,以评估手术内通风参数与临床/实验室结果之间的关联.
主要成果:
- 在手术内通风参数 (如潮体积,PEEP,平均气道压力) 与死亡率,机械通风持续时间或血管压缩器使用之间没有发现显著的关联.
- 潮体积与单细胞和中性粒细胞数量以及术后淋巴细胞数量的变化有正相关性.
- 平原压力与中性粒细胞与淋巴细胞比率 (NLR) 有着强烈的正相关性.
结论:
- 在手术期间的通风策略似乎对接受手术的COPD患者的主要结果和大多数实验室标志物的影响很小.
- 平原压力与NLR的关联要求进一步调查,以了解其临床意义和该患者群体的潜在原因.
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