自主呼吸试验在慢性阻塞性肺病患者撤离人工气道中的作用

The effect of spontaneous breathing trial in extubation in chronic obstructive pulmonary disease patients

目的:探讨自主呼吸试验(SBT)对机械通气的慢性阻塞性肺病(COPD)患者脱离呼吸机、拔出气管插管时间的影响。方法:采用规范的SBT方法拔出气管插管的COPD患者26例(男性19例,女性7例)列入本研究,作为SBT组。同顺性分析末采用SBT方法拔出气管插管的机械通气COPD患者28例(男性24例,女性4例),作为No-SBT组。比较两组患者机械通气时间、拔出气管插管时间(拔管时间),拔管后气管插管复插率(拔出气管插管48h内)心及PaO_2,PaCO_2血清白蛋白,血红蛋白。结果:两组患者的年龄(P=0.683)、机械通气时间(P=0.167)差异无显著性,但是SBT组拔出气管插管的时间(60min)与No-SBT组(40-540min)比较差异有显著意义(P=0.0001)。SBT组和No-SBT组患者拔出气管插管后,需无创通气辅助的患者均为3例(P=0.717),48h内再次气管插管患者前者为2例(2/24),后者为3例(3/28)(P=0.900),再次气管插管的原因均为气道分泌物排出不畅。结论:对COPD患者,在撤离呼吸机、拔出气管插管的过程中采用规范SBT方法可以明显地缩短拔管时间,而且未增加气管插管的复插率。

Objective：To study the effects of spontaneous breathing trial （SBT） in the discontinuing period in mechanically ventilated chronic obstructive pulmonary disease （COPD） patients. Method： Twenty-six COPD patients with protocol-driven extubation strategy with SBT as SBT group （male 19, female 7） were included in the study. Twenty-eight COPD patients （male 24, female 4） without SBT as No-SBT group were retrospected. Duration of mechanical ventilation, reintubation rate （48h after extubation）, duration of extubation, PaO2, PaCO2, levels of blood albumin and hemoglobin were compared between the two groups. Result： All the patients in the two groups were similar in age （P=0.683） and mechanical ventilation duration （P=0.167）. However, the extubation duration in SBT group （60 rain） was significantly different from that （40-540min） in No-SBT group （P=0.0001）. In SBT group, 2 patients who failed within 1-hr SBT were excluded from the study. In each group, there were 3 patients required noninvasive ventilation following extubation （P=0.717）. Two （2/24） patients in SBT group and 3 （3/28） patients in No-SBT group needed reintubation （P=0.900）. Conclusion： The protocol-driven spontaneous breathing trial may shorten the extubation duration in mechanically ventilated COPD patients. Meanwhile, the rate of reintubation does not increased.