重症肌无力术后机械通气脱机方法的比较

Comparison of Weaning methods in patients with myasthenia gravis after thymectomy

目的:比较重症肌无力胸腺切除术后经验性脱机和程序化脱机在机械通气(MV)撤机的临床效果。方法:重症肌无力胸腺切除术后行机械通气的患者67例,根据脱机方式不同分为经验性脱机组和程序化脱机。比较两种脱机方法的MV时间、监护室住院时间、脱机成功率、呼吸机相关性肺炎(VAP)发生率和住院死亡率等差异。结果:两组重症肌无力术后机械通气患者比较,程序化脱机组比经验性脱机组MV时间、监护室住院时间和总住院时间均有明显缩短(P【0.05);VAP发生率和住院死亡率方面,程序化脱机组均明显低于经验性脱机组(均P【0.05)。结论:重症肌无力胸腺切除术后机械通气时采用程序化脱机能明显缩短MV时间和监护室住院时间,提高脱机成功率,降低VAP发生率和住院死亡率,值得临床推广。

Objective:To compare the clinical result of protocol-directed weaning and traditional physician-directed weaning. Methods:67 patients with myasthenia gravis were treated with mechanical ventilation after thymectomy,and the weaning method were separated into protocol-directed weaning and traditional physician-directed weaning.Compare the difference of MV duration,custodial care ward duration,the rate of successful weaning,et al.Results:The protocol-directed weaning group have the shorter duration of MV and in custodial care ward(P<0.05), lower rate of incidence of VAP and the hospital mortality(P<0.05). Conclusion:The mechanical ventilation patients with myasthenia gravis after thymectomy which were treated with protocol-directed weaning have the shorter duration of MV and in custodial care ward,higher rate of successful weaning,lower rate of incidence of VAP and the hospital mortality,and is worthy of spreading in clinical practice.