程序化与非程序化拔除气管插管在重症病房中的应用

With and without protocols on weaning and extubation in ICU

目的:评价程序化脱离呼吸机拔除气管的方法对重症监护病房患者的效果。方法:本研究分两阶段 进行,第一阶段历时4个月,为非程序化部分(n=18);第二阶段为程序化部分,6个月完成(n=28)。程序化拔除 气管插管的患者先接受检测,随即进行自主呼吸实验(spontaneousbreathingtrial,SBT)。SBT是在压力支持呼吸方 式下进行,支持压力为7cmH2O,时间为30～120min。当患者完成自主呼吸实验阶段,而且呼吸频率≤35/min, PaO2≥9.3kPa,浅快呼吸指数≤105时,即可拔出气管插管。结果:两组患者的年龄和机械通气时间没有差异;两组 患者拔除气管插管的时间有显著差异,程序化组为37.32min(30～120min),非程序化组为201.11min (20～540min),气管插管的复插率分别为7%和10%。结论:采用程序化方法脱离呼吸机拔出气管插管可以明显 的缩短拔管时间,而且并未使气管插管的复插率增加。

Objective:To evaluate the efficacy of protocols-directed weaning and extubation on adult patients in ICU. Methods:The research was divided into two phases. The first is no-protocols-driven part(n=18), carried out in four months; the second is protocols-driven part(n=28), carried out in six months. With the protocols, the patients received a test, followed by a spontaneous breathing trial(SBT). An SBT conducted in PSV with 7cm H 2O with the target duration of 30 to 120min. The patients were extubated, when passed the trial with the following, respiratory rate<35; PaO 2≥9.3kPa; rapid shallow breathing index≤105.Results:The groups were similar in age (P=0.33), in mechanical ventilation duration(P=0.75). Extubation duration were significantly different for protocol (37.32min, 30～120min) and no protocol(201.11min, 20～540min). The reintubation rate were 7% in protocol group and 10% in no-protocol group. Conclusions:Use of protocol-directed weaning and extubation, the extubation dura