生理呼吸功作为呼吸机撤离指标的临床研究

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

目的评价生理呼吸功（ＷＯＢｐｈｙ）对机械通气患者撤机的指导意义。方法监测患者呼吸功（ＷＯＢｔ）和器械导致的附加功（ＷＯＢｉｍｐ）推算ＷＯＢｐｈｙ。不符合常规撤机标准者，以ＷＯＢｐｈｙ＜０．７０Ｊ／Ｌ为撤机标准，观察是否撤机成功。结果４１例患者中２８例符合常规撤机标准（常规组），拔管后１例再插管。１３例患者不符合常规撤机标准（非常规组），但ＷＯＢｐｈｙ均低于０．７０Ｊ／Ｌ全部拔管，其中１例再插管。非常规组ＷＯＢｔ（１．３７±０．５０Ｊ／Ｌ）和ＷＯＢｉｍｐ（０．８２±０．３７Ｊ／Ｌ）与常规组（０．９６±０．３８和０．５５±０．２７Ｊ／Ｌ）比较，差异均有显著性。但两组比较ＷＯＢｐｈｙ差异无显著性。结论以ＷＯＢｐｈｙ＜０．７０Ｊ／Ｌ作为撤机标准是安全的，有利于及时撤机拔管。

Objective To evaluate the physiologic work of breathing (WOB phy ) as a predicting Parameter of weaning and extubation. Methods WOB phy was obtained by the patient′s work of breathing (WOBt), minuting the imposed work of breathing (WOB imp ). In weaning trial, if the patients could not meet predefined extubation criteria, but WOB phy <0.70 J/L, the patients were also extubated immediately. Results In a group of 28 patients who met the predefined criteria (group 1), 27 patients were successfully extubated. In another group of 13 patients who could not meet the criteria, but WOB phy <0.70 J/L (group 2), extubation was successful in 12 patients. WOBt and WOB imp were significantly higher in group 2 (1.37±0.50 and 0.82±0.37 J/L ) than group 1 (0.96±0.38 and 0.55± 0.27 J/L, P < 0.05), while WOB phy was higher in group 2, but did not reach statastical significance. Conclusions WOB phy <0.70J/L may be safe as the weaning and extubation criterion and enables earlier extubation.