不同自主呼吸试验方式在机械通气患者撤机中的比较

Comparison of two modes of spontanenous breathing trail for weaning from mechanical ventilation

目的比较两种自主呼吸试验(spontaneous breathing trail,SBT)方式对有创机械通气患者撤机的影响,并分析其可能的影响因素。方法将120例使用有创机械通气、经治疗后具备撤机指征的重症患者随机分为T管脱机组(T组,60例)和低水平压力支持通气(Pressure support ventilation,PSV)组(P组,60例),分别采用T管脱机和低水平PSV的方式进行自主呼吸试验,每组再根据患者是否合并慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)分为T1、T2组和P1、P2组,比较T组和P组以及各亚组患者的平均带机时间和拔管成功率。结果 T组与P组的带机时间及撤机成功率无显著差别(P>0.05),但对于既往存在COPD病史的患者,采用低水平PSV法进行自主呼吸试验,拔管成功率为86.8%,较T管脱机组患者高(P<0.05),患者平均带机时间40.0h,明显短于T管脱机组患者(P<0.05)。结论对于使用有创机械通气的重症患者采用T管脱机或低水平PSV法进行自主呼吸试验均不影响患者的拔管成功率,但对于存在肺部基础疾病的患者,采用低水平PSV的方法撤机成功率更高。

Objective To compare two modes of spontaneous breathing trail（SBT） for weaning from mechanical ventilation,and to analysis the potential influential factors.Methods 120 critical patients who were accepted invasive ventilation in this research were selected.When they have the criteria for weaning,they were divided into two groups and four subgroups with different modes of SBT either T-tube or Pressure support ventilation（PSV） for weaning.The mean ventilation time and extubation ratio were compared between the two groups and among the four subgroups.Result Two groups had the similar ventilation time and extubation ratio（P0.05）;But for patients who had chronic obstructive pulmonary diseases（COPD）before,the extubation ratio of p1 subgroup was 86.6% which was higher than that of T1 subgroup（P0.05）,and the ventilation time of P1 subgroup was 40.0 hours which was shorter than that of T1 subgroup（P0.05）.Conclusion Neither T-tube nor PSV can influence the extubation ratio for critical patients,but in patients with COPD,PSV was more successful weaning method than T-tube.