程序化脱机在重症脑卒中患者中的应用研究

A study on application of programmed weaning in patients with severe stroke

目的 评价程序化脱机在神经重症加强治疗病房（NICU）重症脑卒中患者机械通气（MV）中的应用价值.方法 选择2011年10月至2016年12月河北大学附属医院收治的需要MV的重症脑卒中患者65例,分别采用程序化脱机（程序组35例）和经验性脱机（经验组30例）两种方法对行MV的重症脑卒中患者进行脱机.比较两组脱机成功率、脱机前MV时间、总MV时间、住NICU时间、气管切开率、48 h再插管率、NICU住院费用、呼吸机相关性肺炎（VAP）发生率的差异.结果 与经验组比较,程序组脱机成功率明显提高〔68.6％（24/35）比33.3％（10/30）〕,脱机前MV时间、总MV时间、住NICU时间、NICU住院费用及VAP发生率明显降低〔脱机前MV时间（d）：9.69±1.30比12.45±2.01,总MV时间（d）：15.14±2.01比18.38±3.58,住NICU时间（d）：22.14±2.09比28.57±3.05,NICU住院费用（万元）：4.9±0.6比6.5±0.5,VAP发生率：8.6％（3/35）比40.0％（12/30）,均P〈0.05）〕.程序组气管切开率、48 h再插管率与经验组比较差异均无统计学意义〔气管切开率：51.4％（18/35）比63.3％（19/30）,48 h再插管率：14.3％（5/35）比13.3％（4/30）,均P〉0.05〕.结论 程序化脱机较传统经验脱机能提高脱机成功率,缩短MV时间,降低并发症发生率,减少住院费用,为重症脑卒中患者提供了一种安全有效的脱机方式.

Objective To evaluate the value of programmed weaning in mechanical ventilation （MV） for patients with severe stroke in neurological intensive care unit （NICU）. Methods Sixty-five patients with severe stroke necessary to use MV for treatment were enrolled in the Affiliated Hospital of Hebei University from October 2011 to December 2016, they were divided into a programmed group （35 cases） with programmed weaning, and an experiential group （30 cases） with experiential weaning. The differences in success rate of weaning, MV time before weaning, total MV time, NICU stay time, traeheotomy rate, 48-hour re-lntubation rate, NICU hospitalization expenses, the incidence of ventilator-associated pneumonia （VAP） were compared between the two groups. Results Compared with the experiential group, the success rate of weaning of the programmed group was significantly increased [68.6% （24/35） vs. 33.3% （10/30）], while the MV time before weaning, total MV time, NICU stay time, NICU hospitalization expenses and the incidence of VAP were obviously decreased [MV time before weaning （days）： 9.69 ± 1.30 vs. 12.45 ± 2.01, total MV time （days）： 15.14 ± 2.01 vs. 18.38 ± 3.58, the NICU stay time （days）： 22.14 ± 2.09 vs. 28.57 ± 3.05, NICU hospitalization expenses （wan yuan）： 4.9±0.6 vs. 6.5±0.5, the incidence of VAP： 8.6% （3/35） vs. 40.0% （12/30）, all P 〈 0.05]. There were no significant differences in traeheotomy rate and 48-hour re-intubation rate between the programmed group and the experience group [traeheotomy rate： 51.4% （18/35） vs. 63.3% （19/30）, 48-hour re-intubation rate： 14.3% （5/35） vs. 13.3% （4/30）, both P 〉 0.05]. Conclusion Compared with traditional experience weaning, the programmed weaning can improve the success rate of offline, shorten the MV time, reduce the incidence of eomplieations, decrease hospital costs and provide a safe and effective offline mode for patients with severe stroke.