中文摘要：

目的探讨内科重症监护病房（MICU）患者撤机困难的相关因素。方法回顾分析2010年4月至2011年4月收治的112例接受呼吸机辅助通气患者的临床资料，其中男63例，女49例，年龄（58±26）岁；基础疾病主要包括慢性阻塞性肺疾病急性加重（AECOPD）27例、肺炎20例、哮喘12例、神经肌肉疾病8例等。记录患者入院时基本情况、基础疾病、伴随疾病情况及撤机前的生理指标变化。将患者分为成功撤机组和撤机困难组，应用Logistic回归分析等分析与撤机困难有关的危险因素。结果撤机困难患者共27例（24．1％），其中基础疾病在两组间的分布差异有统计学意义的是：AECOPD（χ^2=6．238，P=0．028）、特发性肺纤维化（χ^2=5．232，P=0．025）、神经肌肉疾病（χ^2=14．635，P=0．007），撤机困难比例分别为9／27、2／6、6／8；两组间入院时氧合指数及撤机前氧合指数差异均有统计学意义（t=2．183，2．162，均P〈0．05）；两组间撤机前的Zubrod评分差异有统计学意义（t=9．037，P〈0．05）；Logistic回归结果显示：严重心功能不全、精神心理疾病、阻塞性睡眠呼吸暂停、AECOPD及神经肌肉疾病的患者更易出现撤机困难（OR值分别为5．781、4．654、4．012、3．617及2．885）。结论严重心功能不全、精神心理疾病、阻塞性睡眠呼吸暂停、AECOPD、神经肌肉疾病是MICU患者撤机困难的主要危险因素；患者的氧合功能以及自主行为能力也对撤机产生影响。

英文摘要：

Objective To explore the related factors of difficult-to-wean patients in medical intensive care unit （MICU）. Methods A retrospective analysis was performed for 112 patients placed on mechanical ventilation. There were 63 males and 49 females with a mean age of （58 ± 26） years. Their primary diseases included acute exacerbation of chronic obstructive pulmonary disease （AECOPD） （n = 27 ）, pneumonia （ n = 20） , asthma （ n = 12） and neuromuscular diseases （ n = 8 ）. Basic admission profiles, underlying diseases, accompanying diseases and pre-weaning changes in physiological indicators were recorded. They were divided into 2 groups： successfully-weaned group and different-to-wean group. Logistic regression analysis was used to analyze the risk factors correlated with the difficult withdrawal of mechanical ventilation. Results There were 27 （24. 1% ） difficult-to-wean patients on mechanical ventilation in MICU. Some underlying diseases had statistical significance in both groups, including AECOPD （ χ^2 = 6. 238, P = 0. 028 ）, idiopathic pulmonary fibrosis （ χ^2 = 5. 232, P = 0. 025 ） and neuromuscular disease （χ^2 = 14. 635, P = 0. 007 ）. The ratios of difficult-to-wean patients were 9/27, 2/6 and 6/8 respectively. There was statistical significance of pre-admission and pre-weaning oxygenation index between two groups （ t = 2. 183, 2. 162, P 〈 0. 05 ）. Zubrod score at pre-weaning was also significantly different between two groups （ t = 9. 037, P 〈 0. 05 ）. Logistic regression indicated that the patients with severe heart failure （ OR = 5. 781 ） , psychological disorders （ OR = 4. 654 ）, obstructive sleep apnea （ OR = 4. 012 ）, AECOPD （ OR = 3. 617 ） and neuromuscular diseases （OR = 2. 885 ） were more vulnerable to weaning difficulties. Conclusion The major risk factors of difficult-to-wean patients in MICU include severe heart failure, psychological diseases, obstructive sleep apnea, neuromuscular disease and AECOPD. And oxygenation and