生理呼吸功指导呼吸机脱机的临床意义

Clinical application of physiologic work of breathing as a respiratory weaning parameter in mechanically ventilated patients

目的:评价生理呼吸功(WOBphy)对机械通气患者脱机的指导作用。方法:测定患者呼吸功(WOBt)和器械附加功(WOBimp)。并推算WOBphy。不符合常规脱机标准者,如WOBphy<0.70J/L,仍立即脱机拔管。结果:41例患者中28例符合常规脱机际准(常规组),WOBphy均<0.70J/L,拔管后1例再插管。13例患者不符合常规脱机标准(非常规组),WOBt高达1.37±0.50J/L,但 WOBphy均于0.70J/L,立即拔管后仪1例再插管。结论:以WOBphy<0.70J/L作为脱机标准,比常规脱机际准更准确。

Objective:To evaluate the physiologic work of breathing (WOBphy)as parameter of respiratory weaning and extubation. Method: Patient work of breathing (WOBt) and imposed work of breathing (WOBimp) were measured. WOBphy was obtained with WOBt minuting WOBimp. In the patients who did not meet conventional respiratory weaning parameters ,if WOBphy<0.70 J/L, the weaning and extubation were performed immediately. Result:In 28 patients who met the conventional weaning parameters with WOBphy<0.70J/L,27 patients were extubated successfully. In 13 patients who did not meet the conventional parameters.WOBt was 1.37±0.50 J/L,but WOBphy was determined not to be excessive(<0.70 J/L)in all patients,the weaning and extubation were successful in 12 patients, only 1 patient required reintubation within 48 h. Conclusion:In mechanically ventilated patients, WOBphy<0.70J/L as a respiratory weaning parameter is more accurate than conventional parameters are.