目的:探讨有创机械通气患者的甲状腺功能与呼吸机撤机的关系,评价甲状腺功能和呼吸机撤机结局的相关性和意义。方法:选取2018年1月—2020年12月入住广东医科大学附属高明医院ICU、有创机械通气时间＞48 h并曾进行甲状腺功能测定的重症患者126例,根据拔管后24 h内是否需再次有创机械通气分为撤机成功组和撤机失败组,记录和比较两组患者的年龄、机械通气时间、急性生理学和慢性健康状况评分系统Ⅱ(acute physiology and chronic physiology,APACHEⅡ)评分、甲状腺功能测定结果等。结果:126例有创机械通气患者中,撤机成功86例,撤机失败40例。撤机成功组游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)水平明显高于撤机失败组(P＜0.05),撤机成功组患者的总三碘甲状腺原氨酸(total triiodothyronine,TT3)、总甲状腺激素(total thyroid hormone,TT4)和促甲状腺激素(thyroid stimulating hormone,TSH)水平与撤机失败组比较差异无统计学意义(P＞0.05)。Logistic多元回归分析显示FT3和FT4水平是有创机械通气患者撤机失败的保护因素。结论:有创机械通气患者甲状腺功能水平与病情严重程度相关,FT3和FT4水平低下是导致撤机失败的重要原因之一。
Objective: To investigate the relationship between thyroid function and ventilator weaning in patients with invasive mechanical ventilation, and to evaluate the correlation and significance of thyroid function and ventilator weaning outcome. Methods: A total of 126 critically ill patients admitted to ICU of Gaoming Hospital Affiliated to Guangdong Medical University from January 2018 to December 2020 with invasive mechanical ventilation time>48 h and thyroid function test were selected.According to whether invasive mechanical ventilation was needed within 24 h after extubation, they were divided into successful weaning group and failure weaning group.The age, mechanical ventilation time, Acute Physiology And Chronic Physiology (APACHEⅡ) Score and thyroid function test results of the two groups were recorded and compared. Results: Among 126 patients with invasive mechanical ventilation, 86 cases were successfully withdrawn and 40 cases were failed.The levels of free triiodothyronine (FT3) and free thyroxine (FT4) in the successful weaning group were significantly higher than those in the failure weaning group (P＜0.05); there was no significant difference in the levels of total triiodothyronine (TT3), total thyroid hormone (TT4) and thyroid stimulating hormone (TSH) between the successful weaning group and the failure weaning group (P＞0.05).Logistic multiple regression analysis showed that FT3 and FT4 levels were the protective factors for weaning failure in patients with invasive mechanical ventilation. Conclusion: The level of thyroid function in patients with invasive mechanical ventilation is related to the severity of the disease.The low level of FT3 and FT4 is one of the important reasons for weaning failure.
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