摘要
目的探讨临床检测氧代谢指标在机械通气患者呼吸机撤离时机把握中的应用价值,为指导临床撤机时机提供依据。方法 32例慢性阻塞性肺病(chronic obstructive pulmonary diseases,COPD)并发呼吸衰竭患者给予有创机械通气治疗后准备转无创机械通气,依据撤机成功或失败分为序贯成功组22例和序贯失败组10例。全程监测血乳酸、中心静脉血氧饱和度(ScvO2),并进行急性生理和慢性健康评分(APACHEⅡ)。结果序贯成功组血乳酸和ScvO2均在正常范围内,序贯失败组血乳酸高于正常,ScvO2<70%;序贯成功组撤机前血乳酸水平与APACHEⅡ呈正相关,ScvO2与APACHEⅡ呈负相关。结论 COPD患者在肺部感染控制窗出现的同时监测氧代谢指标有助于指导有创-无创序贯机械通气,提高患者脱机成功率,减低再插管率。
Objective To explore the guiding value of oxygen metabolism detection for determination of an appropriate time in which patients could be changed from invasive to non-invasive mechanical ventilation. Methods Thirty-two patients with chronic ob- structive pulmonary diseases (COPD) were divided into two groups:sequential therapeutic success (n = 22) and sequential therapeutic failure (n = 10) according to the final clinic outcome. The blood lactate,central venous oxygen saturation (ScvO2) and APACHE 11 were monitored during the whole course. Results Both plasma lactate and ScvO2 returned to normal range at 2 h before endotracheal intubation was removed in sequential therapeutic success group, while the indexes did not in the sequential failure group. Correlation and regression analysis showed that blood lactate, ScvO2 has the positive and negative correlation with APACHE II , respectively. Conclusion Monitoring oxygen metabolism can guide when COPD patients could be changed from invasive to non-invasive mechanical ventilation within pulmonary infection control window. Tbat may improve the success rate of the sequential tberapy and reduce the rate of reintubation.
出处
《实用医院临床杂志》
2012年第4期81-84,共4页
Practical Journal of Clinical Medicine
关键词
氧代谢
血乳酸
中心静脉血氧饱和度
机械通气
Oxygen metabolism
Blood lactate
Central venous oxygen saturation
Mechanical ventilation