| Objective1.To analyze the Influencing factors of secondary intubation in patients with AECOPD combined with type? respiratory failure treated by mechanical ventilation in intensive care unit,and to determine the independent risk factors of secondary intubation.To analyze the predictive value of each index in independent risk factors for secondary intubation in patients with mechanical ventilation.2.To study the relationship between the albumin before extubation,diaphragmatic displacement and secondary intubation in patients with mechanical ventilation.To examine whether the diaphragm can act as a mediator between albumin and ventilator weaning in patients with mechanical ventilation.Methods1.From June 2016 to June 2017 in the intensive care department of the second hospital of tianjin medical university,a retrospective case-control study was carried out to analyze the medical records of patients with AECOPD complicated with type ? respiratory failure.According to the ventilator weaning results,the patients were divided into two groups: one-time successful detaching group and two-time intubation group.Social demographic data and blood test indexes were collected including gender,age,self-care ability in daily life,muscle strength,albumin before extubation,hemoglobin before extubation,creatinine before extubation,using hormone before extubation,expectoration capacity,amount of sputum,nutritional status,BNP,APACHE? score,pulmonary hypertension,duration of mechanical ventilation,duration of stay in ICU,etc.T test or chi-square test was used to compare the data between the groups,and univariate Logistic regression analysis was conducted to analyze the influencing factors of secondary intubation.Then,variables with P<0.05 were included in the multivariate binary regression analysis with secondary intubation as the dependent variable,and independent risk factors of secondary intubation were obtained.The predictive value of each indicator was evaluated using the recriver operating characteristic curve(ROC).2.From June 2017 to March 2018 in the intensive care department of the second hospital of tianjin medical university,a prospective study was conducted on patients treated with mechanical ventilation.As the patient stabilizes,spontaneous breathing test(SBT)will be conducted for about 1 hour when the patient is ready to weaning.During the period,B-mode ultrasound examination was performed to measure the diaphragmatic displacement for the patient.When SBT was completed,blood samples were sent for blood gas analysis and blood routine and biochemical examination results.According to the ventilator weaning results,the patients were divided into two groups: one-time successful detaching group and two-time intubation group.Diaphragmatic displacement measured by chest ultrasound and serum albumin before extubation were recorded.SPSS24.0 was used for statistical analysis.First,K-S test was used to analyze the normal distribution of albumin before extubation and diaphragmatic displacement.Pearson correlation method was used to analyze the correlation between albumin before extubation and diaphragmatic displacement.Using two independent samples T test,the correlation between albumin before extubation and secondary intubation was analyzed.And the correlation between diaphragmatic displacement and secondary intubation was analyzed.Using the mediating method,depending on the type of the variable.Linear regression was used to analyze the relationship between albumin and diaphragmatic displacement.Single factor analysis was used to investigate the effect of albumin on weaning results and diaphragmatic displacement on weaning results.Multivariate analysis was used to analyze the effect of albumin and diaphragmatic displacement on the weaning results.Further,Sobel test was used to analyze whether diaphragm could be used as a mediator between albumin and weaning results.Results1.Mechanical ventilation in the treatment of AECOPD combined with type ? respiratory failure of secondary intubation in patients with single factor and multiple factors analysis resultsBy comparing the two groups(one-time successful detaching group and two-time intubation group),we obtained that there were significant differences in the age,albumin before extubation,hemoglobin before extubation,daily life self-care ability,APACHE ? score,expectoration capacity,the quantity of sputum,nutrition condition assessment,duration of mechanical ventilation,duration of stay in ICU.The difference was statistically significant(P< 0.05).Single factor Logistic regression analysis results showed that age,albumin before extubation,hemoglobin before extubation,daily life self-care ability,nutrition condition assessment,APACHE ? score,expectoration capacity,duration of mechanical ventilation,the quantity of sputum,duration of stayed in ICU to influence patients with AECOPD combined with type? respiratory failure treated by mechanical ventilation,the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that the albumin before extubation,hemoglobin before extubation were independent risk factors for secondary intubation in patients with mechanical ventilation,and the difference was statistically significant(P< 0.05).Using ROC curve analysis of albumin before extubation and hemoglobin before extubation in the two groups continuous variables following results: Albumin before extubation predicted secondary intubation optimal threshold is 30.4 g/L,sensitivity: 65.4%,speciality rate: 77.8%,the area under the curve(AUC): 0.731(0.616,0.846),positive predictive value: 86.56%(74.35,94.37),negative predictive value: 50.72%(36.07,65.28).The optimal critical value of hemoglobin before extubation for predicting secondary intubation was 111.5g/L,sensitivity: 37.3%,specificity: 94.4%,area under the curve: 0.671(0.550,0.792),positive predictive value: 92.73%(75.88,99.14),negative predictive value: 44.01%(32.56,55.95).2.Correlation analysis of albumin before extubation,diaphragmatic displacement and secondary intubation in patients with mechanical ventilation,analysis of the mediating effect of the diaphragm on albumin and weaning resultsUsing pairwise correlation comparison,first,K-S test is adopted.The measurement data of normal distribution of albumin before extubation and diaphragmatic displacement were obtained.Pearson correlation study showed that there was a correlation between albumin before extubation and diaphragmatic displacement.Whether the weaning results are performed with secondary intubation is a binary variable.Two independent samples were used to analyze the correlation between albumin before extubation and secondary intubation.The diaphragmatic displacement is also correlated with the secondary intubation.Using the mediating method,Statistical analysis was conducted according to variable types,and the results showed that: The effect of albumin on the diaphragmatic displacement was statistically significant.The effect of albumin on offline results was statistically significant.The effect of diaphragm mobility on offline results was statistically significant.However,albumin and the diaphragm act together weaning as a result,the difference was not statistically significant.Further adopting Sobel test method,the results showed that mediating effect of diaphragm on albumin and weaning results,the difference was not statistically significant.Diaphragm was not a mediator between albumin and weaning results.Conclusions1.Mechanical ventilation in the treatment of patients with AECOPD combined with type? respiratory failure,albumin and hemoglobin before extubation are independent risk factors influencing patients with secondary intubation.2.In patients with mechanical ventilation,there was a correlation between albumin and the diaphragmatic displacement,albumin before extubation was correlated with the result of weaning,the diaphragmatic displacement was correlated with the result of weaning.The diaphragmatic displacement is not a mediator of albumin and weaning outcomes. |
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