动态监测气道闭合压在预测脱机成功率中的应用

Application of a serial measurement of airway occlusion pressure in prediction weaning from mechanical ventilation/

目的：探讨动态监测气道闭合压（Ｐ０．１）在预测成功脱机中的应用意义。方法：各种呼吸衰竭需要机械通气患者在应用压力支持通气（ＰＳＶ）脱机时，每８小时测定１次Ｐ０．１，同时记录患者的潮气量（ＶＴ）、通气量（ＶＥ）、呼吸频率（ＲＲ）、潮气末二氧化碳分压（ＥＴＣＯ２）、经皮血氧饱和度（ＳｐＯ２），以及压力支持（ＰＳ）水平，将患者分为脱机成功组（２４例）和脱机失败组（１６例）进行对照分析。结果：在ＰＳＶ期间，脱机成功组Ｐ０．１、ＶＥ均无明显变化（Ｐ＞０．０５）；脱机失败组Ｐ０．１结束前值（０．７５±０．３６ｋＰａ，１ｋＰａ＝１０．２０ｃｍＨ２Ｏ）与基础值（０．４１±０．２８ｋＰａ）以及与脱机成功组同期值（０．２７±０．０９ｋＰａ，０．２８±０．１５ｋＰａ）比较均明显升高（Ｐ均＜０．０１），ＶＥ较脱机成功组明显升高（Ｐ＜０．０５）。Ｐ０．１与ＶＥ明显相关（ｒ＝０．６２，Ｐ＜０．０５）。结论：动态观察Ｐ０．１，对于常规参数处于边缘值欲脱机患者将可明显提高脱机成功率。

Objective:To evaluate application of a serial measurement of airway occlusion pressure (P 0.1 ) combined with traditional weaning parameters in prediction weaning from mechanical ventilation.Methods:During weaning from pressure support ventilation (PSV),P 0.1 was measured per eight hours in patients with respiratory failure needing mechanical ventilation.V T,V E,RR,E TCO 2,SpO 2 and pressure support (PS) levels were recorded simultaneously in these patients.Patients were divided into two groups: successful weaning group (24 cases) and failure weaning group (16 cases).Results:During PSV,P o.1 ,V E in successful group were not markedly changed ( P >0.05).In failure group,P o.1 of perend value (0.75±0.36kPa,1kPa=10.20cm H 2O) was significantly higher than that of basal value (0.41±0.28 kPa),and also those of successful group (0.27±0.09 kPa,0 28±0 15kPa, all P <0.01).Similarly,V E in failure group was significantly higher than that in successful group ( P <0.05).A significant correlation was found between P 0.1 and V E ( r =0.62, P <0.05).Conclusions:P o.1 has been shown to be a predictor for the ability of ventilated reserve.Decision of weaning from marginal value of conventional parameters combined with a serial measurement of P 0.1 would significantly increase successful rate of weaning from mechanical ventilation in patients.