自主呼吸试验在撤机中的应用

目的 对应用自主呼吸试验(SBT)撤机方式与逐渐降低机械通气支持水平撤机方式成功拔管的患者进行比较,以寻找最佳撤机方式.方法 选择57例机械通气患者,病情稳定后通过撤机试验前评估,然后准备撤机.采用前后对照的方法将患者分为两组,2004年6月-2005年12月的21例患者作为对照组,采用逐渐降低机械通气支持水平的撤机方式拔管;2006年1月-2007年3月的36例患者作用为试验组,采用SBT的撤机方式拔管.分别观察两组患者的机械通气时间、住重症监护病房(ICU)时间、呼吸机相关性肺炎(VAP)发生率、48 h内再插管率、ICU病死率.结果 试验组与对照组的机械通气时间分别为(59.45±37.1)h和(111.4±59.8)h(P=0.001),住ICU时间分别为(8.0±5.5)d和(15.3±14.3)d(P=0.034),VAP发生率分别为16.7%和38.0%(P=0.070),48 h内再插管率分别为19.4%和5.0%(P=0.253),ICU病死率分别为25.0%和24.0%(P=0.920).结论 SBT的撤机方式比逐渐降低机械通气支持水平的撤机方式具有机械通气时间和住ICU时间短的优点,而两组VAP发生率、48 h内再插管率、ICU病死率基本相同.

Clinical experience of spontaneous breathing trial in weaning mechanical ventilation

Objective To compare the spontaneous breathing trial(SBT)weaning mode with the classical weaning mode for extubation in patients undergoing mechanical ventilation.Methods Fifty-seven patients showing stabilized condition after mechanical ventilation,were divided into two groups.In 21 patients,admitted from June 2004 to December 2005,a gradual decrease in respiratory support as the mode of weaning of mechanical ventilation.In 36 patients,admitted from January 2006 to March 2007,SBT weaning mode was adopted.The length of mechanical ventilation and stay in intensive care unit(ICU),ventilator-associated pneumonia(VAP)rate,retubing rate in 48 hours,ICU mortality were compared between two groups.Results The length of mechanical ventilation were(59.4±37.1)hours and(111.4±59.8)hours(P=0.001),length of stay in ICU were(8.0±5.5)days and(15.3±14.3)days(P=0.034),VAP rate was 16.7% and 38.0%(P=0.070),retubing rate in 48 hours were 19.4% and 5.0%(P=0.253),ICU mortality rate was 25.0% and 24.0%(P=0.920)in SBT group and control group,respectively.Conclusion The SBT weaning mode shortens the time of mechanical ventilation and the ICU stay days.Both groups have the identical VAP rate,retubing rate in 48 hours,and ICU mortality.