自主呼吸试验在COPD机械通气患者撤机中的作用

Effect of spontaneous breathing trial in weaning of mechanical ventilation in patients with chronic obstructive pulmonary disease

目的评估自主呼吸试验(SBT)在COPD机械通气患者撤机过程中的作用。方法选择52例COPD机械通气撤机成功的患者,分为两组:S组24例,采用SBT方式撤机拔管;NS组28例,采用逐渐降低机械通气支持水平的方式撤机拔管。对比两组患者的拔管时间、住重症监护病房(ICU)时间、呼吸机相关性肺炎(VAP)发生率、48 h内再插管率以及住院病死率。结果 S组与NS组的拔出气管插管时间120 min和(300.01±65.23)min)、住ICU时间(9.50±4.20)d和(18.60±10.30)d、VAP发生率12.50%和28.57%,均有统计学差异(P<0.05),而48 h内再插管率20.83%和21.43%、ICU病死率16.67%和17.85%,无统计学差异(P>0.05)。结论应用SBT法撤机比渐减机械通气支持水平的方法具有更早拔出气管插管、住ICU时间短的优点,而且降低了VAP的发生率。

Objective To assess the effect of spontaneous breathing trial （SBT） in the weaning process of mechanical ventilation of patients with chronic obstructive pulmonary disease （COPD）. Methods 52 COPD patients were randomly divided into two groups. The S group （ n = 24 ） was extubated by the SBT method, and the NS group （ n = 28 ） was extubated by the method of decreasing mechanical ventilatory support level gradually. The duration of extubation and ICU stay, the incidence of ventilator - associated pneumonia （VAP） and reintubation rate within 48h, and hospital mortality were compared between the two groups. Results The time of extubation and ICU stay was 120 min and 9.5 ±4.2 days in the S group and 300. 01 ±65.23 min and 18.6 ± 10. 3 days respectively in the NS group, and the incidence of VAP was 12.50% and 28.57% respectively in the S group and the NS group with significant difference （ P 〈 0. 05 ）. The re- intubation rates were 20. 83% and 21.43% and mortalities were 16.67% and 17.85% respectively in the S group and the NS group with no significant difference （P 〉 0. 05 ）. Conclusion SBT weaning method can greatly shorten the duration of extubation and ICU stay and lower the incidence of VAP while compared with the method of decrease of mechanical ventilation support level gradually.