机械通气时人机对抗31例临床分析

Resistance to Respiratory Ventilators in Mechanical Ventilation:A Clinical Analysis of 31 Cases

目的分析机械通气患者发生人机对抗的主要原因和解决方法。方法回顾性分析急诊监护室收治的31例人机对抗患者临床资料,总结发生人机对抗的主要原因和解决方案。结果31例出现人机对抗的患者包括:主观不耐受16例,严重感染6例,心力衰竭5例,潮气量不足2例,气管插管痰栓阻塞1例,单肺通气1例。其中22例成功撤机,6例撤机困难,3例死亡。其中12例给予1次以上的地西泮静脉推注后好转,11例给予地西泮10 mg静脉推注1次后症状好转,6例给予丙泊酚泵控静脉滴注后好转,2例给予丙泊酚后症状无明显缓解。结论主观不耐受、病情变化和呼吸机调节不当及通气管道不畅等是人机对抗的主要因素。及时与患者及其家属沟通,设置合适的通气模式和(或)参数,注意病情变化,及时祛除诱因可避免和减少人机对抗的发生。

Objective To analyse the prime reasons of resistance to respiratory ventilators in mechanical ventilation to find out its solutions.Methods Retrospective analysis was performed on clinical data of 31 patients with resistance to respitatory ventilators in ICU to sum up its main reasons and solutions.Results Of 31 patients with resistance to respiratory ventilators,16 turned out to have subjective intolerance,6 with severe infection,5 with heart failure,2 with insufficient tidal volume,1 with endotracheal intubation sputum blockage and 1 with one-lung ventilation.Twenty-two were successfully disconnected with respiratory ventilators,but it was proved difficult for aother 6.Three patients died.Eleven patients improved after treated with an intravenous injection of 10 mg diazepam,6 with pump-controlled intravenous drips of propofol and 12 with over-one-time intravenous injection of diazepam,and 2 did not present any obvious relief after given propofol.Conclusion Such objective factors as subjective intolerance,changes of pathogenetic conditions,and improper adjustment of respiratory ventilators and ventilator pipes are the main factors of patients’ resistance to respiratory ventilators in mechanical ventilation.Timely communication with patients and their family members,suitable set-up of ventilation models and(or) parameters,attention to pathogenetic conditions and timely removal of remote causes can avoid and reduce its occurrence.