计划性脱机与经验性脱机的临床比较

A clinical comparison between protocol-directed weaning from mechanical ventilation and traditional physiciandirected

目的比较计划性脱机与经验性脱机的优劣。方法 71位患者分成两组,做前后对照的前瞻性研究。结果与对照组相比,试验组机械通气(MV)的时间明显缩短(53．00 h vs 156．50 h,P=0．042); 开始脱机前的机械通气(MV)时间显著减少(15．00 h vs 92．00 h,P=0．000);住院死亡率明显降低 (34．3％ vs 61．1％,P=0．024);呼吸机相关性肺炎和气管切开的发病率显著下降(P<0．05)。试验组脱机成功率高于对照组(68．6％ vs 47．2％,P=0．069),而住院费用较低(67 256．12元 vs 104 570．76元,P= 0．295)。结论脱机方案指导的计划性脱机是安全的,它能提高医生的脱机意识、减少MV的时间和并发症、降低住院病死率。

Objective To compare the practice of protocol-directed weaning from mechanical ventilation （MV） with traditional physician-directed weaning. Methods A prospective before-after controlled trial in 71 adult patients receiving MV in intensive care unit （ICU） was conducted. Patients were assigned to receive either protocol-directed （ n = 35） or physician-directed （ n = 36） weaning from MV. Results The median duration of MV was 53.00 hours in the protocol- directed group compared with 156.50 hours in the physician-directed group （P = 0.042）. The median length of MV from the exact time of tracheal intubation until the start of the weaning process was 15.00 hours in the protocol-directed group and 92.00 hours in the physician-directed group （ P = 0.000）. The hospital mortality was significantly lower in the protocoldirected group compared with the physician-directed group （34.3% vs 61.1%, P = 0.024）. Pneumonia and tracheostomy associated with ventilation were significantly fewer in the protocol-directed group （ P 〈 0.05 ）. The rate of successful weaning was higher for patients receiving protocol-directed weaning （68.6% vs 47.2% , P = 0.069） and hospital costs were lower （67 256.12 RMB vs 104 570.76 RMB, P = 0.295）, though the difference were not significant. Conclusion Protocol-directed weaning from MV was safe. It improved physician＇s awareness about weaning, reduced the duration of MV and hospital mortality, and had fewer complications.