两种自主呼吸测试方法在肝移植患者脱离呼吸机时的应用

Clinical Observation of Two Methods for Spontaneous Breathing Trial in Liver Transplant Patients Weaning from Mechanical Ventilation

目的在程序化脱离呼吸机拔出气管插管的过程中,分别采用T型管和压力支持通气(pressure suppsrt venti-lation,PSV)对肝移植术后患者进行30m in的自主呼吸试验(spontaneous breath ing trial,SBT),比较两者的临床效果。方法28例患者随机分为T型管组(n=12)和PSV组(n=16)。程序化拔除气管插管分两个步骤进行,即检测阶段和SBT阶段。当患者完成SBT阶段,而且呼吸频率≤35次/m in,PaO2≥70 mmHg,即可拔出气管插管。结果两组患者均成功进行了SBT、拔出气管插管。T型管组在30 m in时完成SBT者为10例(10/12),PSV组为13例(13/16)。两组患者平均机械通气时间分别为(22.23±17.86)h(T型管组)和(31.91±34.11)h(PSV组),P=0.3805;拔除气管插管前血清白蛋白、血红蛋白含量没有差别,但均低于正常值。结论应用T型管和PSV进行30m in的SBT,临床结果相似。短时间(<48 h)接受机械通气的非COPD患者,血中低水平的血清白蛋白、血红蛋白可能对拔除气管插管影响不大。

Objective To evaluate the efficacy of pressure support ventilation(PSV) and T-Tube for spontaneous breathing trial(SBT) in liver transplant patients weaning from mechanical ventilation.Methods 28 patients were randomly divided into PSV group(n=16) and T-Tube group(n=12).SBT was attempted in PSV with 7 cmH_2O or T-Tube with FiO_2≤5 L/min.The target duration of SBT was 30 to 120 min.The patients passed the trial with the following:respiratory rate <35;PaO_2>70 mmHg;and rapid shallow breathing index<105.Results The patients of the two groups matched in age(P=0.6377) and duration of mechanical ventilation(P=0.3805).All patients were extubated successfully.In PSV group,10 patients(10/12) passed SBT in 30 min,and in T-Tube group 13 patients passed(13/16).Both albumin and hemoglobin were at low levels.Conclusion 30 min spontaneous breathing trial with T-tube or PSV is a suitable method for weaning from ventilator support.Patients who received mechanical ventilation within 48 hours may not be less likely to be successfully extubated with lower albumin and hemoglobin levels.