Ti/Ttot和f/VT对COPD机械通气患者撤机的指导作用

Study on the guiding significance of Ti/Ttot and f/VT on weaning from ventilator with COPD

目的:探讨Ti/Ttot(吸气时间分数)和f/VT(浅快呼吸指数)在COPD(慢性阻塞性肺病)机械通气患者撤机中的指导意义。方法:选择EICU(急诊重症监护病房)的43例COPD撤机患者,应用BICORE-CP100呼吸监测仪床边监测病人Ti/Ttot、f/VT和常规撤机指标VT(潮气量)、RR(呼吸频率)、VE(每分钟通气量)、MIP(最大吸气压),撤机成功组与撤机失败组指标评分进行相互比较。其中,RR、VT在SPT(自主呼吸试验)开始时测定,观察其对撤机的指导意义。结果:撤机成功组28例,Ti/Ttot 0.31±0.03,f/VT 92±12;撤机失败组15例,Ti/Ttot 0.38±0.01,f/VT 104±9。撤机失败组Ti/Ttot、f/VT、MIP、VE均明显高于撤机成功组,相互比较有显著差异(P<0.05);VT明显低于撤机成功组,相互比较有显著差异(P<0.05)。结论:Ti/Ttot和f/VT对撤机都有重要指导作用,但单个仍非敏感指标,对COPD患者应同时结合临床指标更为可靠。

Objective：To investigate the guiding significance of Ti/Ttot （inspiratory time/ respiratory cy- cle time） and f/VT （frequency/tidal volume ratio） on weaning from ventilator in patients with COPD. Methods：Ti/ Ttot, f/VT, VT （tidal volume）, RR （respiratory rate）, VE （minute ventilation） and MIP （maximal inspiratory pres- sure） of 43 patients with COPD in EICU were monitored by the breath tester BICORE-CP100. Then, comparisons were done between the successful weaning group and the failed group. RR and VT were monitored at the very begin- ning of SPT （spontaneous breathing trial）. Results：In the successful weaning group of 28 patients,Ti/Ttot 0.31±0. 03 and,f/VT 92-12bpm/L. In the failed group of the other 15 patients,Ti/Ttot 0. 38± 0. 02 and, f/VT of 104±9bpm/L. Compared with the successful weaning group,Ti/Ttot,f/VT, MIP and VE in the failed group were higher significantly （P〈0.05）. Conclusion： Ti/Ttot and f/VT both had important guiding significance on weaning from ventilator, while each individual one is still non-sensitive indicator, so we should adjust the treatment also according to the clinical indexs.