睡眠状态下的浅快呼吸指数预测慢性阻塞性肺疾病急性加重期患者撤机的研究

Clinical value of rapid shallow breathing index in predicting ventilator weaning in sleeping patients with acute exacerbation chronic obstructive pulmonary disease

目的研究睡眠状态下的浅快呼吸指数(RSBI)对慢性阻塞性肺疾病急性加重期(AECOPD)患者撤机的临床意义,探讨用排除精神因素干扰后的浅快呼吸指数指导撤机的时机。方法符合AECOPD机械通气指南建议撤机的患者随机分为试验组和常规组,计算不同意识状态下的RSBI,均以<105bpm/L作为标准,分别予以评估撤机时机,常规组以清醒状态下测定的RSBI作为撤机预测指标,试验组以睡眠状态下的RSBI作为撤机预测指标,评估机械通气时间及撤机成功率。结果常规组与试验组在机械通气时间上分别为(9.24±3.02)天和(7.78±1.97)天,差异有统计学意义(P<0.05),撤机成功率分别达到78.7%和81.4%,差异无统计学意义(P>0.05)。结论睡眠状态下测定的RSBI能够避免了意识状态对撤机指标的影响,更早预测撤机时机,有效的缩短有创机械通气时间。

Objective To assess the clinical value of rapid shallow breathing index （RSBI） in predicting ventilator weaning in sleeping patients with acute exacerbation chronic obstructive pulmonary disease （AECOPD）and to explore the optimal weaning time excluding mental interference.Methods A total of 60 mechanically ventilated patients with AECOPD admitting to ICU in Baoding No.1 Hospital were enrolled in this study.All patients with AECOPD who met ACCP guideline for mechanical ventilation and weaning were divided into conventional group and experimental group.In conventional group,physiological parameters and RSBI were recorded and calculated in the waking state,while in experimental group,physiological parameters and RSBI were recorded and calculated in the sleeping state.Comparison was performed in the success rates of ventilator weaning and duration of ventilation between groups.Results Duration of ventilation was significantly longer in conventional group than in experimental group （[9.24±3.02]days and [7.78 ± 1.97]days,repectively,P 0.05 ）.Conclusion RSBI can prevent mental interference from influencing ventilator weaning indicator in sleeping patients with COPD and,it can also predict weaning time earlier and shorten effectively mechanical ventilation time.