The relationship between body mass index and mechanical ventilation time in patients with acute exacerbation of chronic obstructive pulmonary disease / 中国医师进修杂志

ABSTRACT

Objective:To investigate the relationship between body mass index (BMI) and invasive mechanical ventilation time in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:Medical records of 72 patients with AECOPD admitted to Zhejiang Xin′an International Hospital from June 2018 to December 2019 were retrospectively analyzed. According to BMI, they were divided into the low body mass group (BMI<18.5 kg/m 2), the normal body mass group (18.5 kg/ m 2 ≤ BMI < 24.0 kg/m 2), and the obesity and overweight group (BMI ≥ 24.0 kg/m 2). According to the time of invasive mechanical ventilation of patients, they were divided into invasive mechanical ventilation time>7 d group and ≤ 7 d group. The changes of baseline data in each group were compared, and the risk factors of invasive mechanical ventilation time of patients with AECOPD were analyzed. Results:The incidence of hypertension and diabetes in the obesity and overweight group were higher than those in the low body mass group 11/15 vs. 31.8(7/22), 8/15 vs. 13.6%(3/22), P<0.05. Before intubation, the level of ALB in the obesity and overweight group was higher than that in the normal body mass group and the low body mass group (34.77 ± 5.11) g/L vs.(33.02 ± 4.86), (29.13 ± 3.64) g/L, the level of ALB in the normal body mass group was higher than those in the low body mass group , and there were significant differences ( P<0.05). The time of invasive mechanical ventilation in the obesity and overweight group was shorter than that in the normal body mass group and the low body mass group(9.51 ± 1.38) d vs. (11.03 ± 1.91), (14.11 ± 2.36) d, the time of invasive mechanical ventilation in the normal body mass group was shorter than that in the in the low body mass group, and there were significant differences ( P<0.05). But there were no statistically significant differences in gender, age, smoking, complicated gastrointestinal bleeding, abdominal distension, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, exudation, ventilator modes, pH values, arterial partial pressure of carbon dioxide (PaCO 2) before intubation and arterial partial pressure of oxygen (PaO 2) before intubation of patients in the three groups ( P>0.05). Complicated diabetes mellitus, gastrointestinal bleeding, abdominal distension, BMI<18.5 kg/m 2, the rate of exudation and APACHEⅡscore in the invasive mechanical ventilation time ≤ 7 d group were lower than those in the invasive mechanical ventilation time>7 d group. Before intubation, ALB levels in the invasive mechanical ventilation time ≤ 7 d group were higher than those in the invasive mechanical ventilation time >7 d group ( P<0.05). The Logistic regression analysis results showed that complicated gastrointestinal bleeding, abdominal distension, BMI<18.5 kg/m 2, APACHEⅡscore > 10 points, before intubation, ALB< 30 g/L were independent risk factors of invasive mechanical ventilation time of patients with AECOPD ( P<0.05). Conclusions:In addition to the mechanical ventilation related complications and high APACHEⅡscore, malnutrition is an important risk factor affecting invasive mechanical ventilation time of patients with AECOPD before intubation.