智能化撤机在慢性阻塞性肺疾病中的应用

Comparative Study between SmartCare Weaning and Protocol-Directed Weaning in COPD Patients

目的比较SmartCare智能化撤机(SC)和程序化撤机(SBT)在慢性阻塞性肺疾病(COPD)撤机阶段的患者舒适度、医护人员工作量、撤机时间、撤机成功率和机械通气相关并发症的差异。方法将准备撤机的COPD患者随机分为SC组和SBT组,撤机计划开始后每日给予两组患者和医护人员视觉模拟评分(VAS)评价舒适度和工作量,0分为舒适度最差和工作量最多,10分为舒适度最好和工作量最少。同时记录两组血气分析的次数、撤机成功率、撤机时间、自行拔管率、48 h内再插管率和呼吸机相关性肺炎(VAP)发生率。结果纳入COPD患者40例,SC组19例,SBT组21例。患者和医护人员前3 d的VAS评分SC组均显著高于SBT组(P<0.05)。撤机时间SC组[(4.7±2.7)d]少于SBT组[(5.5±3.2)d],但差异无统计学意义(P>0.05)。两组的血气分析次数、撤机成功率、48 h内再插管率、自行拔管率和VAP发生率比较均无显著差异(P>0.05)。结论SC法相对于SBT法,可以提高COPD患者撤机阶段的舒适度并减轻医护人员的工作负担,有相似的撤机成功率,但未能证实可以缩短COPD患者的撤机时间及减少机械通气相关的并发症。

Objective To compare the advantages between SmartCare weaning and protoco directed weaning in COPD patients regarding five aspects including comfort degree of COPD patients in weaning stage, workload of medical staff, weaning success rate, weaning time, and complications associated with mechanical ventilation. Methods COPD patients who＇ s planning to receive ventilation weaning were randomly divided into a SmartCare weaning group （SC group） and a protocol-directed weaning group （SBT group）. The comfort degree of patients and workload of medical staff were assessed by the visual analogue scale （VAS） as the weaning plan started. 0 was for the most discomfort and maximal workload, and 10 was for the most comfort and minimal workload. Data from the following aspects had been recorded： times of blood gas analysis, weaning success rate, weaning time, self-extubation rate, the rate of re-intubation within 48 hours, and ventilator-associated pneumonia （VAP） incidences. Results 40 patients were selected and divided into the SC group （ n = 19） and the SBT group （ n = 21 ）. There was no significant difference in the enrolled age and APACHE II between two groups. The VAS scores was higher in the SC group than that in the SBT group in the first three days （P 〈0. 01 ）. The weaning time was shorter in the SBT group than that in the SBT group [ （4.7 ~ 2. 7 ） days vs. （5.5 ±3.2） days ], without significant difference between two groups （P 〉 0. 05 ）. There were no differences in times of blood gas analysis, weaning success rate, weaning time, self-extubation rate, the rate of re-intubation within 48 hours, and ventilator-associated pneumonia （VAP） incidences between two groups （ P 〉 0. 05 ）. Conclusion As compared with protocol-directed weaning, SmartCare weaning can increase comfort degree of patients and reduce the workload of medical staff with similar weaning success rate, weaning time, and complications associated with mechanical ventilation.