Burns脱机评分量表作为机械通气脱机流程启动标准的临床研究

A clinical study of Burns wean assessment program as mechanical ventilation weaning procedures initiation criteria

目的:研究Burns脱机评分量表(BWAP)作为重症监护病房(ICU)机械通气(MV)患者程序化脱机流程启动标准的应用价值。方法:选取2017-07-2019-06期间收住在我院综合ICU的161例MV患者为研究对象,根据入院前后分经验组和BWAP组,分别通过医生经验判断和BWAP评分作为程序化脱机流程的启动标准,比较两组在MV时间、住ICU时间、住院总时间、自主呼吸试验(SBT)通过率、拔管成功率和28 d病死率上的差异。结果:与经验组相比,BWAP组明显缩短首次SBT前MV时间,首次拔管前MV时间和住ICU时间[首次SBT前MV时间(h):84(41.5,135)vs.134(56.5,224.25),首次拔管前MV时间(h):90(44.5,155.5)vs.137.5(59.25,271.5),住ICU时间(d):8(5,13)vs.11.00(4.25,22),均P<0.05]。两组在首次拔管成功率,总住院时间和28 d病死率上的差异无统计学意义[首次拔管成功率:87.64%(78/89)vs.81.94%(59/72),总住院时间(d):21(14,29.5)vs.27(15,37.75),28 d病死率:5.60%(5/89)vs.12.50%(9/72),均P>0.05]。结论:作为程序化脱机流程的启动标准,使用Burns脱机评分量表较医生经验性判断,可以明显缩短患者机械通气时间,减少住ICU时间,为重症患者提供一个客观、方便和全面的脱机前评估方法。

Objective: To study the application value of Burns wean assessment program(BWAP) as programmed weaning for Intensive Care Unit(ICU) mechanical ventilation(MV) patients. Method: A total of 161 MV patients admitted to our comprehensive ICU from July 2017 to June 2019 were selected as subjects. According to the experimental group and BWAP group, the doctors’ experience judgment and BWAP score were used as the starting criteria for programmed weaning procedures. The differences between the two groups in MV time, ICU stay time, total hospital time, SBT pass rate, extubation success rate, and 28-day mortality were compared. Result: Compared with the experimental group, the BWAP group significantly shortened the MV time before the first SBT, the MV time before the first extubation and the ICU stay time[MV time before the first SBT(h): 84(41.5,135) vs. 134.5(56.5,224.25), MV time before the first extubation(h): 90(44.5,155.5) vs. 137.5(59.25,271.5), the ICU stay time(d): 8(5, 13) vs. 11(4.25, 22), all P<0.05]. There was no significant difference in the success rate of first extubation, total hospital stay, and 28-day mortality between the two groups[the success rate of first extubation: 87.64%(78/89) vs. 81.94%(59/72), total hospital stay(d): 21(14, 29.5) vs. 27(15, 37.75), 28-day mortality: 5.6%(5/89) vs. 12.5%(9/72), all P>0.05]. Conclusion: As the starting standard for the programmed weaning procedures, using the BWAP compared with the doctor’s empirical weaning BWAP can significantly shorten the patient’s mechanical ventilation time, reduce the ICU stay time, and provide an objective, convenient and comprehensive weaning evaluation method for critically ill patients.