人工气道患者非计划拔管事件的评价

Appraisal of unplanned endotracheal extubation in artificial airway patient

目的 探讨非计划拔管事件再插管或未再插管的原因与意义。方法 对重症监护室非计划拔管事件再插管组与未再插管组进行比较分析。结果 呼吸机通气模式在两组间有显著差异 ,非计划拔管事件发生时SIMV(同步间歇指令通气 )与CMV(控制指令通气 )的再插管率 (80 8% )比用CPAP(持续气道正压通气 )与T管给氧拔管的再插管率 (31 8% )显著增高 (P <0 0 1)。再插管组气道分泌物评分高 ,氧合指数低 (PaO2 /FiO2 ) (P <0 0 1)。GCS评分在再插管组与未再插管组无差异(P >0 0 5 )。结论 非计划拔管事件发生后应从患者整体情况评估是否需要再次插管 ,其中着重评估呼吸支持模式、气道分泌物、氧合指数 。

Objective To investigate the cause and significance of reintubation or not in patients of unplanned endotracheal extubation(UEE).Methods Compare and analyze of patients who were reintubated and who were not reintubated after UEE.Results There were significant differences between the two groups for the ventilator modes.The average reintubation rate when SIMV (synchronized intermittent mandatory ventilation) and CMV (control mandatory ventilation) were used (80.8%) in patients was significantly higher than that of CPAP(continous positive airway pressure) and T-piece used(31.8%) ( P <0 01).The airway secretion scale was higher while the oxygenation index (PaO 2/FiO 2) was lower in the reintubated group( P <0 01).Glasgow Coma Scale showed no significant difference.Conlusion Reintubation in UEE patients should not be considered mandatory.It is important to assess the general condition of patients,especially the ventilator modes,airway secretion,oxygenation index prior to determination of reintubation.GCS have little significance. [