摘要
目的:探讨影响术后机械通气患者呼吸机撤离的相关参数,寻找具有预测价值的指标,为指导临床撤机时机提供依据。方法:选择术后机械通气后准备撤机的患者68例,记录撤机开始时的血流动力学指标,包括心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP);呼吸力学指标,包括呼吸频率(RR)、潮气量(VT)、分钟通气量(MV)、浅快呼吸指数(RSBI)、肺顺应性(Crs)、气道峰压(Ppeak)、气道闭合压(P0.1);血气分析指标,包括血乳酸浓度(lac)、动脉血pH值(pHa)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2),并计算氧合指数(PaO2/FiO2);胃黏膜酸度包括胃黏膜pH值(pHi)、胃黏膜二氧化碳分压(PgCO2)。低水平(5-8 cmH2O)压力支持通气下行60 min自主呼吸实验,按撤机结果分为撤机成功组和撤机失败组。应用SPSS12.0软件包对数据进行统计学分析,采用χ2检验和t检验筛选与撤机有关的阳性指标,采用Logistic回归分析阳性指标中与撤机相关的参数。结果:68例术后机械通气患者完成了本实验,其中撤机成功患者42例,撤机成功率为61.8%。单因素分析表明,RR、VT、RSBI、Ppeak、pHi、PgCO2是与撤机有关的阳性指标(P〈0.05)。Logistic多因素回归分析表明,RSBI、P0.1、pHi是影响撤机的相关参数(P〈0.05)。结论:RR、VT、RSBI、Ppeak、pHi、PgCO2是与撤机有关的阳性指标,而RSBI、P0.1、pHi是影响撤机的相关参数。
PURPOSE: To find out indexes predicting weaning outcome and prefer guideline for weaning by analyzing the related factors during weaning from mechanical ventilation in postoperative patients. METHODS: Sixty-eight postoperative patients undergoing mechanical ventilation and preparing to be weaned were involved in this study. When beginning weaning, the indexes measured were haemodynamics parameters including heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial blood pressure(MAP); respiratory mechanics parameters including respiratory rate(RR), tidal volume(VT), minute ventilation(MV), rapid-shallow-breathing index(RSBI),pulmonary compliance(Crs), airway peak pressure(Ppeak), airway occlusion pressure 0.1 s after the beginning of inspiration(P0.1); blood gas analysis consisted of lactic acid(lac), arterial pH(pHa), arterial partial pressure of oxygen(PaO2), arterial partial pressure of carbon dioxide(PaCO2), arterial oxygen saturation(SaO2), and oxygenation index(PaO2/FiO2). Other indexes were gastric intramucosal pH(pHi) and gastric intromucosal PCO2(PgCO2). According to weaning outcome after spontaneous breathing trial within 60 minutes with pressure supported ventilation(PSV) of 5-8 cm H2 O,Sixty-eight cases were divided into two groups: weaning success and weaning failure. SPSS 12.0 software package was used for statistical analysis. RESULTS:Among 68 patients included in this study, forty-two were weaned successfully.The weaning success rate was 61.8%. On univariate analysis, a statistical difference in RR, VT, RSBI, Ppeak, pHi, PgCO2 and PgCO2were found significantly different between the successful and failed weaning trials. A multivariable logistic regression model revealed RVR, P0.1, pHi were the reliable predictors to weaning success from mechanical ventilation in postoperative patients. CONCLUSIONS: RR, VT, RSBI, Ppeak, pHi, PgCO2 were associated with weaning success. RVR,P0.1, and pHi were the reliable predicators to weaning success from mechanical ventilation in postoperative patients.
出处
《中国口腔颌面外科杂志》
CAS
2014年第5期452-456,共5页
China Journal of Oral and Maxillofacial Surgery
关键词
机械通气
撤机
撤机参数
Mechanical ventilation
Weaning
Weaning parameters