Clinical Study Of Main Influential Factors Of Ventilator Weaning In The Elderly Patients With The Long-term Mechanical Ventilation

Objective analyze the main factors of ventilator weaning of the elderly patients(≥60y) who have received long-term mechanical ventilation(≥10d) and discuss the method of ventilator weaning in long-term mechanical ventilation patients.Methods The study group consist of 135 long-term mechanical ventilation patients.Retrospective review the general condition,trachea incision,primary diseases,the first and tenth day's vital signs,accessory examination and acute physiology and chronic health evaluationⅢ(APACHEⅢ)are collected.All the patients are divided into two groups according as the ventilator weaning is successful or failed.Comparative analysis is done in two groups of enacting clinical data.Then divide the successful weaning of patients into simple weaning, difficult weaning, prolonged weaning, comparative analysis is done in three groups of enacting clinical data.Results Ventilator weaning was suceessful for 71 cases,and failed for 64 cases.APACHEⅢscores(d1 d10),Albumin(d1 d10),Mean arterial pressure (d10),Oxygen index(d10),A-aDO2 (d10),Blood lactate(d10),WBC(d10),PLT(d10),Creatinine(d10),Total bilirubin (d10),ALT (d10),Glucose (d10), Hyponatremia (d10) were statistics differences between the two groups(P<0.05).APACHEⅢscores(d10)>60,Blood lactate(d10)>2.0mmol/L were statistics differences between the two groups(P<0.05) in the logistic analysis. The ROC curve and area under the curve of APACHEⅢscore (d10), Blood lactate (d10) are 0.894,0.738; simple weaning 13 cases, difficult weaning 27 cases, prolonged weaning 31 cases. Blood lactate (d10), serum albumin (d10) between the three groups were statistically significant (P<0.05); multi-categorical logistic analysis show that blood lactate (d10)>2.0mmol/L was the degree of difficulty of weaning the independent factors (P <0.05).Conclusion Aggravating primary diseases and severe complication are the main causes of lower success rate of ventilator weaning.The two groups's vital signs,accessory examination and acute physiology are obviously changed in the tenth day. Disease after mechanical ventilation (APACHEⅢscore), blood lactate are the independent factors effect weaning success. The APACHEⅢscore, blood lactate after a period of mechanical ventilation predict weaning success more likely. Blood lactate>2.0mmol/L after mechanical ventilation is the independent factors which effect degree of difficulty of weaning.