目的： 描述非人工气道老年慢阻肺患者痰液潴留（sputum retention）现状，并分析非人工 气道老年慢阻肺患者发生痰液潴留的影响因素。 方法： 采用便利抽样的方法，2018 年 5 月～2019 年 2 月抽取北京市某三甲综合医院呼吸 与危重症医学科（呼吸科病房及呼吸重症监护病房）住院的 60 岁以上的慢阻肺患者进 行调查。采用自行设计的一般情况调查表收集一般资料，采用非人工气道患者痰液潴 留判定标准进行痰液潴留的判定，统计非人工气道老年慢阻肺患者痰液潴留发生率。 结果： 本研究共调查了 117 例 60 岁以上老年慢阻肺患者，结果显示：（1）非人工气道老 年慢阻肺患者痰液潴留发生率 15.4%，其中呼吸科普通病房慢阻肺患者痰液潴留发生 率为 4.6%，呼吸重症病房为 46.7%；（ 2）文化程度为小学及以下人群痰液潴留发生率 较高，患者病情危重、呼吸困难评分高、本次住院有插管史、自理能力差、营养状况 差、既往急性加重住院次数多的患者痰液潴留发生率高，单因素分析具有统计学差异 （P <0.05）； （3）二元 Logistic 回归分析显示，本次住院有插管史（P <0.05，OR=18.753、 既往急性加重次数（P <0.05，OR=8.835）、日常生活活动能力（P <0.05，OR=0.958） 是发生痰液潴留的相关因素。 结论： （1）北京市某三甲医院呼吸与危重症医学科中呼吸重症监护病房非人工气道慢阻 肺患者痰液潴留发生率高，需要医护人员积极采取助排痰措施，避免并发症的发生； （2）患者病情危重、呼吸困难评分高、有插管史的患者、自理能力差、营养状况 差、既往急性加重住院次数多，均对痰液潴留的发生有一定的影响，此外既往急性加 重住院次数、本次住院有气管插管史及自理能力差的老年患者发生痰液潴留风险较高， 提示在今后临床工作中应针对不同的影响因素进行针对性的干预。

Purposes: To describe the status of sputum retention in elderly patients with non-artificial airway COPD, and to explore the possible influencing factors. Methods: Using convenience sampling method，from May 2018 to February 2019, 117 patients were adopted to investigate ,who were over 60 years old hospitalized in the department of respiratory and critical care medicine (respiratory ward and respiratory intensive care unit) of a third-grade grade a general hospital in Beijing. General information was collected by self-designed general situation questionnaire, and the criteria of sputum retention in non-artificial airway patients were used to determine the sputum retention, and the incidence of sputum retention in elderly patients with non-artificial airway COPD was calculated. Results: A total of 117 elderly patients with COPD over 60 years old were investigated in this study. The results showed that :(1) the incidence of sputum retention was 15.4% in elderly patients without artificial airway COPD, including 4.6% in general respiratory ward and 46.7% in respiratory intensive care unit.(2) there was a high incidence of sputum retention in patients with primary school education or below, and a high score for patients with critical illness and dyspnea. Patients with a history of intubation, poor self-care ability, poor nutritional status, and a high incidence of sputum retention in patients with a history of acute exacerbation and a high number of hospitalizations had a high incidence of sputum retention. Univariate analysis showed a statistical difference (P<0.05).(3) binary Logistic regression analysis showed that history of intubation (P<0.05,OR=18.753) ,previous times of acute exacerbation (P<0.05,OR=8.835) and daily life activity (P<0.05,OR=0.958) were the influencing factors for sputum retention Conclusion: (1) There is a high incidence of sputum retention in patients with non-artificial airway
ABSTRACT 
III
 
COPD in the respiratory intensive care unit of a third-grade a hospital in Beijing and the department of respiratory and critical care medicine. Therefore, it is necessary for medical staff to take active measures to assist sputum drainage to avoid complications. (2) Patients with critical illness, dyspnea score high, patients with intubation history, poor self-care ability, poor nutritional status, and previous times of acute exacerbation, have a certain impact on the occurrence of sputum retention. According to different influencing factors, targeted intervention should be carried out.

第一章 文献综述 .................................................... 1
1.1 痰液潴留一词的研究 ......................................................................................... 1
1.1.1 痰液潴留的概念 ......................................................................................... 1
1.1.2 痰液潴留的判定标准 ................................................................................. 2
1.2 慢阻肺患者痰液潴留产生机制 ......................................................................... 2
1.2.1 慢阻肺与气道高分泌 ................................................................................. 2
1.2.2 气道高分泌与痰液潴留 ............................................................................. 3
1.3 慢阻肺患者痰液潴留的相关因素 ..................................................................... 3
1.3.1 年龄 ............................................................................................................. 4
1.3.2 吸烟史 ......................................................................................................... 4
1.3.3 体质指数（Body Mass Index, BMI） ..................................................... 4
1.3.4 气流受限严重程度与呼吸肌肌力 ............................................................. 5
1.3.5 自理能力 ..................................................................................................... 5
1.3.6 机械通气/气管插管 ................................................................................... 6
1.3.7 外科手术 ..................................................................................................... 6
1.3.8 APACHE II 评分 .......................................................................................... 6
1.3.9 出入量 ......................................................................................................... 7
1.4 老年慢阻肺患者痰液潴留的干预 ..................................................................... 7
1.5 小结 ..................................................................................................................... 8
第二章 引言 ........................................................ 9
2.1 立题依据 ............................................................................................................. 9
2.2 研究背景 ............................................................................................................. 9
2.3 研究目的 ........................................................................................................... 10
2.4 操作性定义 ....................................................................................................... 10
第三章 对象与方法 ................................................. 11
3.1 研究对象 ........................................................................................................... 11
3.1.1 研究类型 ................................................................................................... 11
3.1.2 研究样本的选择 ....................................................................................... 11
3.1.3 研究样本量 ............................................................................................... 11
3.2 研究内容与方法 ............................................................................................... 11
3.2.1 一般人口学特征 ....................................................................................... 11
3.2.2 痰液潴留观察表 ....................................................................................... 12
3.2.3 日常生活活动能力 ................................................................................... 12
3.2.4 急性生理与慢性健康评分 ....................................................................... 12
3.2.5 呼吸困难严重程度和肺功能分级 ........................................................... 12
3.2.6 患者营养状况判断 ................................................................................... 13
3.2.7 吸烟指数 ................................................................................................... 13
3.2.8 既往急性加重住院次数 ........................................................................... 13
3.2.9 患者结局 ................................................................................................... 13
3.3 资料收集步骤 ................................................................................................... 13
3.3.1 资料收集前的准备 ................................................................................... 13
3.3.2 资料收集过程 ........................................................................................... 14
3.4 数据分析 ........................................................................................................... 14
3.5 研究质量控制 ................................................................................................... 15
3.6 伦理学考虑 ....................................................................................................... 15
第四章 结果 ....................................................... 16
4.1 研究对象基本信息 ........................................................................................... 16
4.2 老年慢阻肺患者痰液潴留发生现况 ............................................................... 21
4.2.1 痰液潴留发生率 ....................................................................................... 21
4.2.2 发生痰液潴留患者临床特征描述 ............................................................ 21
4.3 老年慢阻肺患者痰液潴留的影响因素分析 ................................................... 24
4.3.1 不同特征患者痰液潴留发生率的比较 ................................................... 24
4.3.2 痰液潴留患者结局特征 ........................................................................... 26
4.4 非人工气道老年患者痰液潴留影响因素的多因素分析 ............................... 27
第五章 讨论 ....................................................... 29
5.1 非人工气道老年慢阻肺患者一般资料 ........................................................... 29
5.1.1 一般资料分析 ........................................................................................... 29
5.1.2 患者肺功能检查率低 ............................................................................... 29
5.2 痰液潴留在呼吸与危重症医学科老年慢阻肺患者中的发生现况 ............... 30
5.2.1 呼吸与危重症医学科慢阻肺患者痰液潴留发生率较高 ....................... 30
5.2.2 重症监护病房痰液潴留发生率高于普通病房 ....................................... 30
5.3 非人工气道老年慢阻肺患者发生痰液潴留临床特征分析 ........................... 31
5.4 非人工气道老年患者痰液潴留的相关因素单因素分析 ............................... 32
5.4.1 文化程度 ................................................................................................... 32
5.4.2 营养状况 ................................................................................................... 33
5.4.3 APACHE II 评分 ........................................................................................ 33
5.5 非人工气道老年慢阻肺患者痰液潴留相关因素的多因素分析 ................... 34
5.5.1 本次住院有气管插管史 ........................................................................... 34
5.5.2 既往每年慢阻肺急性加重住院次数 ....................................................... 34
5.5.3 呼吸困难程度与日常生活自理能力 ....................................................... 35
第六章 结论及展望 ................................................. 37
6.1 研究结论 ........................................................................................................... 37
6.2 研究意义 ........................................................................................................... 37
6.3 研究局限性及展望 ........................................................................................... 38
参考文献 ........................................................... 39
附录 A 知情同意书 .................................................. 45
附录 B 一般情况调查表 .............................................. 46
附录 C 非人工气道患者痰液潴留判定观察表 ............................ 47
附录 D APACHE II 评分 .............................................. 49
附录 E 日常生活活动能力量表（Barthel 指数） ........................ 50
附录 F 呼吸困难量表 mMRC ........................................... 50
附录 G 肺功能分级 .................................................. 50
附录 H 伦理审批表 ................................................... 51
致 谢 .............................................................. 52
北京大学学位论文原创性声明和使用授权说明 ........................... 53
学位论文答辩委员会名单 ............................................. 54
个人简历、在学期间发表的学术论文与研究成果 ......................... 55

[1] 陈亚红. 2019年GOLD慢性阻塞性肺疾病诊断、治疗及预防全球策略解读 [J].中国医学前沿杂 志（电子版）,2019,11(1): 1-14.

[2] Wang C,Xu J,Yang L,et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study[J]. The Lancet, 2018, 391(10131): 1706-1717.

[3] Jessica Evans Y C,Pat G. Camp D M B,Mcrae L. Estimating the prevalence of COPD in Canada Reported diagnosis versus measured airflow obstruction[J]. Statistics Canada,2014, 25(3): 1-11.

[4] 钟相根,祝小惠,郑子安,等. 论“痰”在慢性阻塞性肺疾病发病及治疗中的重要性[J].中华中医药 杂志,2012, 27(12): 3159-3161.

[5] 田勇泉,韩东一,迟放鲁. 耳鼻咽喉-头颈外科学[M].第8版. 北京:人民卫生出版社,2013:466.

[6] 张会芝,刘雪娇,郭桂芳. 非人工气道老年患者痰液潴留判定标准的构建研究[J].中华护理杂 志,2017,52(06): 707-711.

[7] Heather Herdman,Kamitsuru S. Nursing Diagnoses 2015-2017[M]. Tenth Edition ed. 2017.380.

[8] Andrew Webb D A S F. Oxford Textbook of Critical Care[G].Oxford University Press,2016.548-552.

[9] Alves D S N,Frota C T,de Oliveira L M,et al. Profile of nursing diagnoses in patients with respiratory disorders[J]. Invest Educ Enferm,2015,33(1): 112-118.

[10] Andrade L Z C,Silva V M D,de Oliveira Lopes M V,et al. Ineffective airway clearance: prevalence and spectrum of its clinical indicators[J]. Acta Paul Enferm,2014,27(4): 319-325.

[11] Khamiees M,Raju P,Degirolamo A,et al. Predictors of Extubation Outcome in Patients Who Have Successfully Completed a Spontaneous Breathing Trial[J]. chest, 2001, 120(4): 1262-1270.

[12] 刘雪娇,郭桂芳,李湘萍,等. 非人工气道老年患者痰液潴留判定标准准确性的评价[J].中国护理 管理, 2018, 18(10): 1321-1326.

[13] 姚红. 两种排痰方法对COPD患者的护理[J].吉林医学, 2015(11): 2428.

[14] 杨陆,周庆.老年住院病人突发气道梗阻死亡原因分析及预见性护理[J].护理研究(中旬版), 2005, 19(9): 1815-1816.

[15] 王静,苗春艳. ICU患者人工气道内痰痂形成的高危因素及护理对策分析[J].中国医学创新, 2013,10(7): 57-58.

[16] Sousa V,Martins D V. Systematic review and meta-analysis of the accuracy of clinical indicators for ineffective airway clearance[J]. Journal of Advanced Nursing,2014(14): 498-513.

[17] E Puchelle. 气道分泌物的新概念和新功能[J]. 国外医学.呼吸系统分册,1992,12(4): 199-200.

[18] 葛均波,徐永健. 内科学[M].第8版. 北京:人民卫生出版社,2013.

[19] 黄淑君,罗健达,梁蕊. 慢性阻塞性肺疾病气道黏液高分泌祛痰疗法研究进展[J].哈尔滨医科大 学学报, 2018,52(06): 599-602.

[20] 王建枝,钱睿哲. 病理生理学[M].第9版. 北京:人民卫生出版社,2018.

[21] 郭伟,张杰. 慢性阻塞性肺疾病患者气道黏液高分泌的研究与临床治疗[J].中国实用内科杂 志,2007(17): 1390-1391.

[22] Evans C M,Koo J S. Airway mucus:The good, the bad, the sticky[J]. Pharmacology & Therapeutics,2009,121(3): 332-348.

[23] 慢性气道炎症性疾病黏液高分泌管理中国专家共识编写组. 慢性气道炎症性疾病气道黏液高 分泌管理中国专家共识[J].中华结核和呼吸杂志,2015,38(10): 723-729. [24] 田攀文,文富强. 治疗慢性阻塞性肺疾病气道黏液高分泌临床意义[J].中国实用内科杂志, 2015,35(05): 382-385.

[25] Wroblewska I,Olesniewicz P,Kurpas D,et al. Analysis of spirometry results in hospitalized patients aged over 65?years[J]. Clinical Interventions in Aging,2015(10): 1071.

[26] 李彦霖,王思一,刘持.肺衰老与呼吸系统疾病发病关系的研究进展[J].广东医学,2016, 37(6): 925-928. [27] Chilosi M,Carloni A,Rossi A,et al. Premature lung aging and cellular senescence in the pathogenesis of idiopathic pulmonary fibrosis and COPD/emphysema[J]. Translational Research,2013, 162(3): 156-173.

[28] Kohansal R,Martinez-Camblor P,Agust íA,et al. The Natural History of Chronic Airflow Obstruction Revisited[J]. American Journal of Respiratory and Critical Care Medicine,2009,180(1): 3-10.

[29] 王西凤,邢华. 患者肺功能和气道炎性反应的影响[J]. 疑难病杂志, 2013, 12(2): 96-98.

[30] 王晓如,孔庆华,范颖,等. 吸烟与老年慢性阻塞性肺疾病患者肺功能受损程度相关性分析[J].中 国临床医学,2011,18(06): 794-796.

[31] 谢高强,程显声,徐希胜,等. 慢性支气管炎患者慢性阻塞性肺疾病发病影响因素的研究[J].中华 医学杂志,2001,81(22): 15-18.

[32] Kim V,Oros M,Durra H,et al. Chronic Bronchitis and Current Smoking Are Associated with More Goblet Cells in Moderate to Severe COPD and Smokers without Airflow Obstruction[J]. PLOS ONE, 2015,10(2): e116108.

[33] Habesoglu M,Demir K,Yumusakhuylu A C,et al. Does Passive Smoking Have an Effect on Nasal Mucociliary Clearance?[J]. Otolaryngology-Head and Neck Surgery,2012, 147(1): 152-156.

[34] Nicholas T Vozoris Mhsc Md Frcpc D E O D. Prevalence, risk factors, activity limitation and health care utilization of an obese population-based sample with chronic obstructive pulmonary disease[J]. Canadian Respiratory Journal Journal of the Canadian Thoracic Society,2012,19(3): 18-24.

[35] Koutsoukou A,Koulouris N,Bekos B,et al. Expiratory flow limitation in morbidly obese postoperative mechanically ventilated patients[J].Acta Anaesthesiologica Scandinavica,2004,48(9): 1080-1088.

[36] 彭相文,陈彦平,孙珺,等. 肥胖及膳食因素对COPD发病及预后影响研究进展[J].中国公共卫生 管理,2016,32(04): 471-474.

[37] 解宝泉,戈艳蕾,王红阳,等. 营养不良与慢性阻塞性肺疾病的临床分析[J].中国煤炭工业医学杂 志,2018,21(4): 355-358.

[38] 冯靖,朱宝玉,陈光瑾,等. 慢性阻塞性肺疾病患者中枢呼吸驱动和气道阻力的研究[J].实用心脑肺血管病杂志,2002(02): 76-80.

[39] 冯靖,陈宝元,朱宝玉,等. 老年慢性阻塞性肺疾病稳定期患者呼吸力学和炎症状态的研究[J].中 华老年医学杂志,2006,10(2): 332-335.

[40] 林江涛,林友华,孔繁亮,等. 慢性阻塞性肺疾病患者呼吸肌肌力和耐力的测定[J].中华结核和呼 吸杂志,1995(05): 293-296.

[41] Ambrosino N,Carpene N,Gherardi M. Chronic respiratory care for neuromuscular diseases in adults[J]. European Respiratory Journal,2009, 34(2): 444-451.

[42] 李慧,龙纳,陈茜. 老年CＯPD患者疲乏状况及其相关因素分析[J].中华现代护理杂志,2016, 22(20): 2846-2850.

[43] 任偶诗,郑彩娥,张荀芳,等. 康复健康教育对老年慢性阻塞性肺疾病患者日常生活活动能力及 肺功能的影响[J]. 中华物理医学与康复杂志, 2009,31(6): 409-411.

[44] Beach L,Denehy L,Lee A. The efficacy of minitracheostomy for the management of sputum retention: a systematic review[J]. Physiotherapy,2013,99(4): 271-277.

[45] Alexiou V G,Ierodiakonou V,Dimopoulos G,et al. Impact of patient position on the incidence of ventilator-associated pneumonia: A meta-analysis of randomized controlled trials[J]. Journal of Critical Care,2009,24(4): 515-522.

[46] 冷玉鑫,宋崖含,姚智渊,等. 45°半卧位对机械通气患者呼吸机相关性肺炎影响的Meta分析[J]. 中国危重病急救医学,2012, 24(10): 587-591.

[47] 蒋琪霞,刘娟,刘玉秀. 半卧位不同角度对机械通气患者通气效果和并发症预防效果的临床观 察[J]. 医学研究生学报,2016,29(10): 1083-1088.

[48] Hammon J W,Crawford F A. The characteristics of good thoracic surgical training[J]. The Journal of Thoracic and Cardiovascular Surgery,2014,147(1): 15-17. [49] 周明娟. 肺功能与胸腹外科手术[J].国外医学(呼吸系统分册),2003,23(03): 163-166.

[50] 陈海龙,赵磊,杨晓燕. 三种评分在慢性阻塞性肺疾病急性加重期病情评估的应用进展[J].世界 最新医学信息文摘,2019, 19(12): 85-86.

[51] 徐建群,甄海宁,杨璐瑜. APACHE Ⅱ评分在高龄COPD患者急性加重期的临床价值[J]. 临床肺 科杂志,2013,18(7): 1227-1229.

[52] 李娟,姜辉,罗俊华. APACHEⅡ评分在老年危重症患者中的应用价值[J]. 现代中西医结合杂 志,2012,21(7): 695-696.

[53] King M,Zayas G. COMPOSITIONS AND METHODS FOR IMPROVED MUCUS FUNCTION,2005.

[54] Boucher R C. Cystic fibrosis: a disease of vulnerability to airway surface dehydration[J]. Trends in Molecular Medicine,2007,13(6): 231-240.

[55] 尤黎明. 内科护理学[M].第5版. 北京:人民卫生出版社,2012.

[56] 中华人民共和国卫生部. 中国卫生行业标准-临床常用急救操作技术第4部分：呼吸道分泌物 吸引[S].2012. [57] Restrepo R D,Walsh B K. Humidification During Invasive and Noninvasive Mechanical Ventilation: 2012[J]. Respiratory Care,2012,57(5): 782-788.

[58] Giancario Garuti,Mirco Lusuardi,Bach J R. Management of cough ineffectiveness in neuromuscular disorders[J]. Shortness of Breath,2013,2(1): 28-34.

[59] 徐瑜俊,仇海兵,朱廷昌. 多频震动排痰对COPD合并肺部感染患者排痰效果研究[J].航空航天 医学杂志,2011,22(10): 1215-1216.

[60] 刘岚云,花曼曼,李敏. 多频振动排痰仪对老年慢性阻塞性肺病患者排痰护理的效果观察[J]. 中国医学装备,2014,11(S2): 126-127.

[61] Cazzola M,Rogliani P,Calzetta L,et al. Impact of Mucolytic Agents on COPD Exacerbations: A Pair-wise and Network Meta-analysis[J]. COPD,2017,14(5): 552-563.

[62] 刘慧琳,田兆兴,郑亚安,等.大剂量盐酸氨溴索对气管拔管后气道分泌物增多疗效观察[J].中国 实用内科杂志,2013,33(08): 648-650.

[63] Jaber S,Amraoui J,Lefrant J,et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: A prospective, multiple-center study[J]. Critical Care Medicine,2006,34(9): 2355-2361.

[64] 中华医学会,中华医学会杂志社,中华医学会全科医学分会,等. 慢性阻塞性肺疾病基层诊疗指 南(2018年)[J].中华全科医师杂志,2018,17(11): 856-870.

[65] 郑燕婵,王嘉玲,刘雯雯,等.大型综合性医院呼吸内科2006—2017年住院因素的帕累托图分析 [J].广东医学, 2018,39(16).

[66] Pascoal L M,Alves J P,Carvalho V E.Ineffective airway clearance in adult patients after thoracic and upper abdominal surgery[J]. Applied Nursing Research, 2016(31): 24-28.

[67] de Sousa V E C,de Oliveira Lopes M V,de Araujo. T L. Clinical indicators of ineffective airway clearance for patients in the cardiac postoperative period[J]. Journal of Clinical Nursing,2013,2(12): 193-200. [68] Pascoal L M,de Carvalho J P A,de Sousa V E C,et al. Ineffective airway clearance in adult patients after thoracic and upper abdominal surgery[J]. Applied Nursing Research,2016,31: 24-28.

[69] Lima L H D O,Lopes M V D O,Falc?o R T D S,et al. Intervention for ineffective airway clearance in asthmatic children: A controlled and randomized clinical trial[J]. International Journal of Nursing Practice,2013, 19(1): 88-94.

[70] 中华医学会呼吸病分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南（2013年修订版） [J]. 中国医学前沿杂志（电子版）,2014, 6(2): 67-80.

[71] 慢性阻塞性肺疾病急性加重AECOPD诊治专家组. 慢性阻塞性肺疾病急性加重(AECOPD)诊 治中国专家共识(2017年更新版)[J].国际呼吸杂志, 2017,37(14): 1041-1057.

[72] Fi M. Functional evaluation:The Barthel Index[J]. Maryland State Medical Journal,1965(14): 56-61.

[73] 缪建萍. 营养不良筛查量表在老年住院患者中的应用[D].上海:华中科技大学,2016.

[74] 张爱珍. 医学营养学[G].人民卫生出版社,2001.150.

[75] 边素艳,刘宏斌,刘宏伟,等.30267例住院老年患者不同年龄段疾病谱构成及顺位分析[J].中华保 健医学杂志, 2016,18(06): 465-467.

[76] 吴冬梅,邓秋园,叶炜,等.不同养老模式下老年人生活质量比较及影响因素分析[J].护理研 究,2016,30(14): 1758-1760.

[77] 黄亚玲,毛兵,闵婕,等.慢性阻塞性肺疾病稳定期患者共患疾病与一年急性加重风险的关系研究[J].中华结核和呼吸杂志,2018,41(5): 349-354.

[78] Wang C,Xu J,Yang L,et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study[J]. The Lancet, 2018.

[79] 郭娥. 我国肺功能应用现状调查[D].广州医科大学,2014.

[80] 田攀文,文富强.治疗慢性阻塞性肺疾病气道黏液高分泌临床意义[J].中国实用内科杂志, 2015,35(05): 382-385.

[81] 王辰. 呼吸重症监护室(RICU)建设与管理中的若干问题[Z].南京:20093-13.

[82] Bonde P,Papachristos I,Mccraith A,et al. Sputum retention after lung operation: prospective, randomized trial shows superiority of prophylactic minitracheostomy in high-risk patients[J]. Ann Thorac Surg,2002,74(1): 196-202, 202-203.

[83] 黄友明,王安才,查日田.不同时间气管拔管对慢性阻塞性肺疾病患者机械通气后的影响[J].皖 南医学院学报,2013,32(03): 207-209.

[84] 李刚,罗勇,沈礼娟,等. BMI、睡眠、情绪及文化程度与慢性阻塞性肺疾病相关性的研究[J].临床 肺科杂志,2016,21(09): 1592-1595.

[85] Pirabbasi E,Najafiyan M,Cheraghi M,et al. Predictors' Factors of Nutritional Status of Male Chronic Obstructive Pulmonary Disease Patients[J]. ISRN Nursing,2012: 1-7.

[86] Baarends E M,Schols A M W J,Mostert R,et al. Peak exercise response in relation to tissue depletion in patients with chronic obstructive pulmonary disease[J]. European Respiratory Journal, 1997,10(12): 2807-2813. [87] Sergi G,Coin A,Marin S,et al. Body composition and resting energy expenditure in elderly male patients with chronic obstructive pulmonary disease[J]. Respiratory Medicine,2006,100(11): 1918-1924.

[88] 祝立勇,邓跃林,凌鹏. APACHEⅡ评分对AECOPD患者病情评估的临床价值研究[J].临床肺科 杂志,2008(04): 434-436.

[89] 彭红星,陈芙蓉,杨荣时.两种评分在慢性阻塞性肺疾病急性加重期并呼吸衰竭患者预后中的价 值[J]. 中国老年学杂志, 2014, 34(14): 3879-3881.

[90] 陈萃,叶志霞,李丽,等.气管插管患者拔管后二次插管常见原因与对策分析[J].解放军护理杂志, 2010, 27(08): 596-598.

[91] 马迎民,方秋红,蒋延文,等.自主呼吸试验在慢性阻塞性肺病患者撤离人工气道中的作用[J].中国康复医学杂志,2009,24(12): 1100-1102.

[92] 高心晶,秦英智.咳嗽峰流速对拔管结果预测的临床研究[J].中国危重病急救医学, 2009, 21(7): 390-393. [93] 郭润玲,郭爱芝,王颖,等.Venturi+MR850氧疗在气管插管病人拔管中的应用[J].护理研究,2014,7(28): 2636-2637.

[94] Epstein S K,Ciubotaru R L. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation.[J]. American Journal of Respiratory and Critical Care Medicine,1998,2(158): 489-493.

[95] Global Initiative For Chronic Obstructive Lung Disease（GOLD). Global strategy for the Diagnosis ,Management and Prevention of Chronic Obstructive Pulmonary Disease: 2018 Report.[EB/OL]. http：//www.goldcopd.org,2019-01-04.

[96] Martinez F J,K Han M,Flaherty K,et al. Role of infection and antimicrobial therapy in acute exacerbations of chronic obstructive pulmonary disease[J].Expert Review of Anti-infective Therapy, 2014, 4(1): 101-124.

[97] Demir G,Akkoca O,Do?an R,et al. The evaluation of dyspnea and quality of life in COPD[J]. Journal Article, English Abstract,2003,4(51): 365-372.

[98] 钱佳慧,曹裴娅,吴侃,等. 慢性病对中国老年人日常生活活动能力影响的调查研究[J].中国全科 医学,2016,19(35): 4364-4369.

[99] 孟丽,石婧,邹晨双,等. 老年人衰弱程度与肌肉相关指标关系的初步研究[J].中华老年医学杂 志,2017, 36(12): 1313-1317.

[100] 张黎娟,王飞飞,马少林,等. 慢性阻塞性肺疾病患者膈肌厚度分数与活动耐力和呼吸困难相关 性研究[J].中国实用内科杂志,2017,37(06): 552-554.