呼吸系统功能评分指导机械通气治疗呼吸衰竭撤机的临床研究

Respiratory Function Score Guided Ventilator Weaning in Patients with Respiratory Failure

目的探索呼吸系统功能评分指导机械通气治疗呼吸衰竭撤机的可行性,并评价其治疗效果。方法选择2010年1月至2012年5月接受气管插管和机械通气治疗的呼吸衰竭患者136例,采用前瞻性对照研究方法。随机分为呼吸系统功能评分3～4分撤机组60例、5～6分撤机组51例和传统方法撤机组25例。呼吸系统功能评分撤机组采用呼吸系统功能评分指导撤机。动态观察3组患者机械通气前通气及氧合指标、呼吸功能评分、直接撤机成功率、总撤机成功率、接受机械通气时间、再插管率和呼吸机相关性肺炎(VAP)发生率。结果 3组治疗前各指标相近。3～4分撤机组、5～6分撤机组和传统方法撤机组的直接撤机成功率分别为98.3%(59/60)、82.4%(42/51)和100%(25/25);接受机械通气时间分别为(5.2±2.5)d、(5.0±3)d和(7.5±3.5)d;再插管率分别为0(0/60)、1.9%(1/51)和0(0/25);VAP发生率分别为11.7%(7/60)、13.7%(7/51)和24%(6/25)。3～4分撤机组与传统撤机组比较,直接撤机成功率、总撤机成功率(含无创通气辅助撤机)均无显著性差异(P>0.05);机械通气时间较传统撤机组明显减少(P<0.01),VAP发生率明显降低(P<0.05)。3～4分撤机组直接撤机成功率明显高于5～6分撤机组(P<0.01)。5～6分撤机组与传统撤机组比较,直接撤机成功率下降(P<0.05);但总撤机成功率无显著性差异(P>0.05),机械通气时间明显减少(P<0.05)。结论呼吸系统功能评分指导机械通气治疗呼吸衰竭撤机是安全可行性的,采用呼吸系统功能评分3～4分撤机在不影响撤机成功率的前提下可减少机械通气时间和VAP的发生率。

Objective To estimate the feasibility and efficacy of respiratory function score （RFS） guided ventilator weaning in mechanical ventilated patients with respiratory failure. Methods By a prospective control study, 136 patients with acute respiratory failure who had received endotracheal intubation and mechanical ventilation from January 2010 to May 2012 were randomly divided into three group,/e, a RFS-guided 3-4 group （ n = 60）, a RFS-guided 5-6 group （ n = 51 ）, and a traditional group （ n = 25 ）. The RFS-guided groups underwent ventilator weaning by guidance of RFS 3-4 and 5-6 respectively. The traditional group underwent ventilator weaning by ordinary way. The ventilation and oxygenation index, RFS, direct weaning success rate, total weaning success rate, total mechanical ventilation time, re-intubation rate, and ventilator-associated pneumonia （VAP） incidence rate were observed. Results The direct weaning success rate in the RFS-guided 3-4 group, the RFS-guided 5-6 group, and the traditional group was 98.3% （59/60） ,82. 4% （42/51）, and 100% （25/25）, respectively. The total duration of mechanical ventilation was （5.2 ± 2. 5 ） days, （5.0 ±3.0） days, and （7.5 ±3.5 ） days, respectively, the re-intubation rate was 0 （0/60）, 1.9% （ 1/51 ）, and 0 （0/25）, respectively. VAP incidence rate was 11.7% （7/60）, 13.7% （7/51） and 24% （6/25）, respectively. Compared with the traditional group, the direct weaning success rate and total weaning success rate in the RFS-guided 3-4 group were not significant different（P 〉 0. 05 ） ,whilethe total mechanical ventilation time and VAP incidence rate were significantly lower （P 〈 0. 05 ）. Compared with the traditional group, the direct weaning success rate and total mechanical ventilation time in the RFS- guided 5-6 group were significantly lower （P 〈 0. 05 ）, but the total weaning success rate was not significantly different （P 〉 0. 05）. Compared with the RFS-guided 5-6 group, the direct weaning success rate in the RFS- guided 3-4 group was significantly increased. Conclusions Mechanical ventilator weaning of patients with respiratory failure under RFS guidance is safe and feasible. RFS 3-4 guided ventilator weaning can significantly improve the therapeutic effect.