不同机械通气模式对下腹部外科术后患者撤机的影响

Influence of Different Mechanical Ventilation Modeson Weaning of Patients After Lower Abdominal Surgery

目的比较不同机械通气模式对下腹部外科术后患者撤机的影响。方法收集笔者所在重症医学科中接受有创机械通气的下腹部外科术后患者,按通气模式不同分为两组。对两组各项资料进行分析。再按脱机结果分为两组,以脱机是否成功为因变量,以差异有统计学意义的临床指标为自变量,用Logistic回归分析对呼吸机撤机的影响。结果总共收集76例下腹部外科术后患者,男性占65.8%,患者年龄18~87岁,平均年龄63.87±16.20岁。组间比较,A/C模式组的机械通气时间、48h重新插管率、ICU滞留天数显著高于PSV模式组,脱机成功率显著低于PSV模式组,差异有统计学意义(P<0.05)。脱机成功组的两种通气模式比例和脱机失败组比较,差异有统计学意义(P<0.05)。以脱机情况为因变量,以APACHEⅡ评分、ALB、通气模式等3项指标为自变量,采用Logistic回归分析的进入法进行分析。APACHEⅡ评分、通气模式是脱机成功与否的独立影响因素。APACHEⅡ评分每提高1分,其脱机成功为原来的0.684倍;以A/C组为参照,PSV组脱机成功是其2.791倍(95%CI:1.279~6.089)。结论 PSV模式较A/C模式在下腹部外科术后患者机械通气过程中撤机成功率更高。

Objective To compare the influence of different mechanical ventilation modes on weaning of patients after lower abdomi- nal surgery. Methods The patients receiving invasive mechanical ventilation in our department of critical care medicine after lower abdo- men surgery were selected as subjects, who were divided into 2 groups according to different ventilation modes. The data of the two groups were analyzed. Then according to the offline results were divided into two groups, the success of weaning as the dependent variable, with a statistically significant clinical indicators as the independent variable, using Logistic regression analysis on the ventilator weaning. Results A total of 76 patients after lower abdomen surgery were collected, 65.8% of whom were males, with an age range of 18 - 87 years and a mean age of （63.87 ± 16.20） years. The mechanical ventilation time, 48 h reintubation rate and length of ICU stay in A/C mode group were significantly higher than those in PSV mode group, the weaning success rate in A/C mode group was significantly lower than that in PSV mode group, and the difference was statistically significant （ P 〈 0.05 ）. Weaning success group and weaning failure group had statis- tically significant difference in the proportion of two ventilation modes （ P 〈 0.05）. With weaning as dependent variable, APACHE Ⅱ score, ALB and ventilation mode as independent variables, logistic regression analysis was performed using enter method. APACHE Ⅱ and ventilation mode were independent influencing factors of weaning. If the APACHE Ⅱ score increased by 1 point, the weaning success rate was 0. 684 times the original rate ; with A/C group as reference, the weaning success rate of PSV group was 2. 791 times that of A/C group （95% CI 1. 279 - 6. 089）. Conclusion Compared with A/C mode, PSV mode has higher weaning success rate in the mechanical ventilation process of patients after lower abdomen surgery. Key words Mechanical ventilation modes;Weaning of patients after lower abdominal surgery