肺移植后患者脱机困难的影响因素分析及临床应对策略研究
Analysis of Influencing Factors and Clinical Coping Strategies of Patients with Offline Difficulties after Lung Transplantation

目的：探讨肺移植后患者脱机困难的影响因素，并分析这些因素对患者恢复过程的具体影响，以期为临床提供针对性的护理策略，改善患者的预后。方法：本研究为回顾性分析，选取2022年3月至2024年3月期间在我院ICU接受肺移植并需要机械通气的120例患者作为研究对象。根据脱机过程是否顺利，将患者分为观察组(55例)和对照组(65例)。收集患者的基本信息、生理指标、实验室检查结果、并发症等数据。采用单因素分析和多元逻辑回归分析确定影响脱机困难的主要因素。结果：单因素分析显示，氧分压、二氧化碳分压、C反应蛋白、通气时间、合并肺部基础疾病、痰培养阳性、血清白蛋白、血肌酐、血红蛋白、凝血酶原时间、急性排异反应、慢性排异反应和术后并发症等与脱机困难显著相关(P < 0.05)。多元逻辑回归分析进一步确认了氧分压、二氧化碳分压、C反应蛋白、通气时间、急性排异反应、慢性排异反应和术后并发症为独立影响因素。结论：肺移植后患者脱机困难受多种因素影响，其中氧分压、二氧化碳分压、C反应蛋白、通气时间和排异反应等是关键的影响因素。临床管理中应密切监测这些指标，并针对高风险因素采取有效的预防和干预措施，以提高患者的脱机成功率和改善长期预后。
Objective: To explore the influencing factors of patients with offline difficulties after lung transplantation, and analyze the specific effects of these factors on the recovery process of patients, in order to provide targeted nursing strategies for clinical treatment and improve the prognosis of patients. Methods: This study was a retrospective analysis of 120 patients who underwent lung transplantation and required mechanical ventilation in the ICU of our hospital between March 2022 and March 2024. According to whether the offline process was smooth, the patients were divided into observation group (55 cases) and control group (65 cases). Patients’ basic information, physiological indicators, laboratory test results, complications and other data were collected. Single factor analysis and multiple logistic regression analysis were used to determine the main factors affecting the offline difficulty. Results: Unifactor analysis showed that oxygen partial pressure, carbon dioxide partial pressure, C-reactive protein, ventilation time, pulmonary underlying diseases, sputum culture positive, serum albumin, blood creatinine, hemoglobin, prothrombin time, acute rejection, chronic rejection and postoperative complications were significantly correlated with the difficulty of taking off (P < 0.05). Multiple logistic regression analysis further confirmed that oxygen partial pressure, carbon dioxide partial pressure, C-reactive protein, ventilation time, acute rejection, chronic rejection and postoperative complications were independent influencing factors. Conclusion: The offline difficulties of lung transplantation patients are affected by many factors, among which oxygen partial pressure, carbon dioxide partial pressure, C-reactive protein, ventilation time and rejection reaction are the key factors. These indicators should be closely monitored in clinical management, and effective prevention and intervention measures should be taken for high-risk factors to improve the offline success rate of patients and improve the long-term prognosis.