三种不同脱机方式在慢性阻塞性肺疾病急性加重期中的应用研究

Randomized controlled trial comparing three methods in weaning patients with AECOPD

目的比较程序化脱机法、智能化脱机法和经验性脱机法三种脱机方式在慢性阻塞性肺疾病急性加重期(AECOPD)患者脱机过程中的优劣。方法选取96例行有创机械通气的AECOPD患者,进行随机对照试验。结果程序组和智能组有创机械通气(MV)时间、ICU住院时间均明显短于经验组,差异有统计学意义(P均<0.01)。三组呼吸机相关肺炎(VAP)的发生率分别为18.8%、25.0%、46.9%,差异有统计学意义(P<0.05)。但三组住院病死率、脱机成功率和48 h再插管率差异无统计学意义(P均>0.05)。结论程序化脱机法和智能化脱机法与经验性脱机法比较,均可减少MV时间和ICU住院时间,并明显降低VAP的发生率。

Objective To compare the difference among smart-care weaning , protocol-directed weaning and experience-based weaning in weaning patients with acute exacerbation of chronic obstructive pulmonary disease （ AE-COPD） .Methods Ninety-six patients with AECOPD receiving invasive mechanical ventilation , were selected and randomly divided into three groups .Results Smart-care weaning method and protocol-directed weaning method were significantly shorter than experience-based weaning method in the duration of mechanical ventilation （ MV ） （ P 〈0.01）, the length of stay in the ICU（P〈0.01）.And the incidence rate of ventilator associated pneumonia （VAP） were 18.8%, 25.0%, 46.9%,respectively ,showing significant difference among three groups （ P〈0.05 ） .Howev-er, there was no significant difference in ICU mortality , extubation successful rate and rates of reintubation within 48 hours（all P〉0.05）.Conclusion The smart-care weaning method and protocol-directed weaning method can short-en the duration of MV and the length of stay in the ICU , and reduce the incidence rate of VAP .