呼吸机撤机困难策略的比较研究

呼吸机撤机困难策略的比较研究

[摘要] 目的研究呼吸机难撤机患者不同撤机策略的效能及其

临床意义。方法选择本院重症监护室呼吸衰竭后呼吸机撤机困难患者75例，随机分为5组，分别采用不同的撤机方法，压力支持（psv）撤机组（a组）15例，压力支持联合同步间歇指令通气（psv+simv）组（b组）15例，t管通气撤机组15例（c组），持续气通正压通气（cpap）撤机组15例（d组），同步间歇指令通气（simv）撤机组（e组）15例，观察比较不同撤机策略的效能。结果各组撒机前的基线资料比较，差异无统计学意义（p ＞ 0.05）。psv撤机设置初始压力水平（baseline ps），使患者rr ＜ 25 bpm，vt为5～8 ml/kg临床效果较好。压力支持撤机、压力支持联合同步间歇指令通气撤机效能明显高于t管撤机、cpap撤机、simv撤机，差异有统计学意义（p ＜ 0.05）。结论本文显示全面评估患者情况、把握撤机时机，是策略性撤机的重要内容；且psv程序撤机较其他方法有一定优越性。

[关键词] 呼吸机；撤机困难；策略；压力支持撤机；同步间歇指令通气

comparative study breathing machine ventilator weaning difficult strategy

liu sun ai yuhang1 qin shuangquan2

1. severe medical department, xiangya hospital central-south university in hunan province, changsha 410008, china;

2.emergency department of changde city first people’s hospital in hunan province, changde 415000, china [abstract] objective to research the ventilator patients removed from machine, and investigate the efficiency of different strategies and their clinical significance. methods seventy five cases of respiratory failure patients weaning difficult after breathing machines ventilator were divided into psv group (group a) with 15 cases, simv+psv group( group b) with 15 cases, t tube ventilation group(group c) with 15 cases, cpap group(group c) with 15 cases, simv group with 15 cases, and study the efficacy of different ventilator weaning strategy. results the baseline data of each group before machine had no statistically significant difference (p ＞ 0.05). psv ventilator weaning setting initial pressure level（ baseline ps） to patients’rr < 25 bpm, vt 5－8 ml/ kg, then the clinical effect was good. the removed efficiency of psv, psv+simv was significantly better than the other method such as t-tube, cpap, simv, the difference was statistically significant (p ＜ 0.05). conclusion this paper shows that comprehensive estimate situation, grasp the right opportunity are the important content of the strategic pulled from the machine, and the psv form has obvious preponderance

than other strategies.

[key words] breathing machine; ventilator weaning difficulties; strategies; pressure support from machine; synchronous intermittent instructions ventilation

撤机困难一直是重症治疗领域亟待解决的问题之一，有关难撤机患者的撤机策略的研究，目前尚无统一的方案。国外研究报道认为psv 撤机效能较高，也有主张每天一次t管撤机试验，对于难撤机患者的撤机策略并无统一意见[1-2]。国内对于撤机困难患者的撤机策略研究很少，仅有少量关于不同撤机模式的比较报道。本文笔者对呼吸机撤机困难患者的各种不同撤机模式进行分析比较，探讨临床难撤机患者的撤机策略。

1 资料与方法

1.1 入组标准

选择本院2009年5月~2011年9月入住重症监护室行呼吸机治疗后撤机困难的患者。入组标准：机械通气治疗时间＞48 h，经治疗综合症状好转，生命体征稳定。全部患者符合氧合指标，符合撤机条件，血流动力学稳定，肺部体征改善，未出现新发病灶，循环系统稳定，未用镇静剂、肌松剂，水电解质平衡符合撤机条件。从符合撤机条件的患者中筛选撤机困难者，其中撤机困难的判定依据自主呼吸实验，即在持续正压通气（cpap）模式下，观察其自主呼吸能力，时间不超过2 h。如果患者出现rr＞35~40 bpm，心率或收缩压升高幅度＞20％，出现精神萎靡、烦躁、反常呼吸、大汗等不