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影响术后机械通气患者撤机的相关参数分析 被引量:3

Parameters influencing weaning outcome in postoperative patients undergoing mechanical ventilation
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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.
作者 周徐慧 姜虹
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
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参考文献11

  • 1Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation [J]. Eur Respir J, 2007, 29(5): 1033-1056.
  • 2机械通气临床应用指南(2006)[J].中国危重病急救医学,2007,19(2):65-72. 被引量:822
  • 3Segal LN, Oei E, Oppenheimer BW, et al. Evolution of pattern of breathing during a spontaneous breathing trial predicts successful extubation [J]. Intensive Care Med, 2010, 36(3): 487-495.
  • 4El-Khatib MF, Jamaleddine GW, Khoury AR, et al. Effect of continuous positive airway pressure on the rapid shallow breathing index in patients following cardiac surgery [J]. Chest, 2002, 121(2): 475-479.
  • 5Shikora SA, Benotti PN, Johannigman JA. The oxygen cost of breathing may predict weaning from mechanical ventilation better than the respiratory rate to tide volume ratio [J]. Arch Surg, 1994, 129(3): 269-274.
  • 6Bouachour G, Guiraud MP, Gouello JP, et al. Gastric intramucosal pH: an indictor of weaning outcome from mechanical ventilation in COPD patients [J]. Eur Respir J, 1996, 9(9): 1868-1873.
  • 7Hurtado FJ, Beron M, Olivera W, et al. Gastric intramucosal pH and intraluminal PCO2 during weaning from mechanical ventilation [J]. Crit Care Med, 2001, 29(1): 70-76.
  • 8袁茵,袁世荧,姚尚龙.胃粘膜pH值及二氧化碳分压指导慢性阻塞性肺疾病老年患者撤机的评价[J].中华麻醉学杂志,2007,27(4):377-379. 被引量:5
  • 9Meade M, Gordon G, Cook D, et al. Predicting success in weaning from mechanical ventilation [J]. Chest, 2001, 120 (6 Suppl): 400-424.
  • 10Shen HN, Lin LY, Chen KY, et al. Changes of heart rate variability during ventilator weaning [J]. Chest, 2003, 123 (4): 1222-1228.

二级参考文献39

  • 1Sahn SA,Lakshminarayan S.Bedside criteria for discontinuation of mechanical ventilation.Chest,1973,63:1002-1005.
  • 2Mador MJ.Weaning from mechanical ventilation:what have we learned and what do we still need to know?.Chest,1998,114:672-674.
  • 3Vallverdu I,Calaf N,Subirana M,et al.Clinical characteristics,respiratory functional parameters,and outcome of a two-hour t-piece trial in patients weaning from mechanical ventilation.Am J Respir Crit Care Med,1998,158:1855-1862.
  • 4Manthous CA.The anarchy of weaning techniques.Chest,2002,121:1738-1740.
  • 5Tobin MJ,Perez W,Guenther SM,et al.The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation.Am Rev Respir Dis,1986,134:1111-1118.
  • 6Yang KL,Tobin MJ.A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation.N Engl J Med,1991,324:1445-1450.
  • 7Epstein SK.Evaluation of the rapid shallow breathing index in the clinical setting.Am J Respir Ctit Care Mad,1995,152:545.
  • 8Krieger BP,Campos M.Weaning parameters:read the methodology before proceeding.Chest,2002,122:1873-1874.
  • 9El-Khatib MF,Jamaleddine GW,Khoury AR,et al.Effect of continuous positive airway pressure on the rapid shallow breathing index in patients following cardiac surgery.Chest,2002,121:475-479.
  • 10Manthous CA,Schmidt GA,Hall JB.Liberation from mechanical ventilation:a decade of progress.Chest,1998,114:886-901.

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