程序化拔除气管插管在肝移植术后病人中的应用

Protocol-and non-protocol-directed weaning and extubation in patients after liver transplantation

目的探讨程序化脱离呼吸机拔出气管插管的方法在肝移植病人中的效果.方法本研究分为两个阶段,第一阶段研究历时10个月,为非程序化组(n=17).第二阶段研究历时8个月,为程序化组(n=28).程序化拔除气管插管分两个步骤进行,即检测阶段和自主呼吸实验阶段(spontaneous breathing trial,SBT).SBT采用压力支持方式或T型管进行,时间为30～120 min.当病人完成自主呼吸实验阶段,而且呼吸频率≤35次/min,PaO2≥70mmHg,浅快呼吸指数≤105时,即可拔出气管插管.结果两组病人的年龄(P=0.6732)和机械通气时间(P=0.8477)没有差异;两组病人拔除气管插管的时间有显著差异(P=0.0001),程序化组为35.54 min(30～105 min),非程序化组为218.24 min(20～740 min);非程序化组中有一例病人于48 h内再次进行气管插管.结论肝移植病人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 protocol-directed weaning and extubation in patients after liver transplantation. Methods The study was divided into 2 phases. The first was the non-protocol-directed phase in 17 patients that lasted for 10 months. The second was the protocol-directed phase in 28 patients that lasted for 8 months. Using the protocols, the patients received a test followed by a spontaneous breathing trial (SBT). The SBT conducted in PSV with 7 cmH2O or in T-tube with the target duration of 30-120 min. The patients passed the trial with the following indexes: 1) respiratory rate ≤35; 2) PaO2 ≥70 mmHg; 3) rapid shallow breathing index < 105. Results All the patients in the 2 groups were similar in age (P=0.6732) and mechanical ventilation duration (P=0.8477). However, the extubation duration in the protocol-directed group (35.54 min, 30-105 min) was significantly different from that (218.24 min, 20-740 min) in the non-protocol-directed group (P=0.0001). Only one of the patients in the protocol-directed group was reintubated in 48 h. Conclusions Using the protocol-directed weaning and extubation, the extubation could be shortened in the patients after liver transplantation. Meanwhile, the rate of reintubation is not increased.