自主呼吸试验联合无创连续心脏指数监测指导呼吸机撤离及对预后的影响

Spontaneous breathing trial combined with non-invasive continuous cardiac index monitoring guide ventilator weaning and its impact on prognosis

目的探讨自主呼吸试验(SBT)联合无创连续心脏指数监测(NiCCI)对机械通气撤机和预后的影响。方法选择2017年10月至2019年3月因呼吸衰竭收住河南省人民医院患者44例,随机分为联合监测(SBT+NiCCI)组和对照(SBT)组。两组患者均通过撤机筛查,SBT组患者通过SBT即给予撤机,SBT+NiCCI组患者通过SBT且连续监测心脏指数在2.6 L/(min·m^2)以上时给予撤机。选取撤机成功率和平均撤机时间作为主要观察指标,平均住院时间和28 d病死率作为次要观察指标,以评价SBT联合NiCCI监测对机械通气撤机和预后的影响。采用软件SPSS 25.0进行统计分析,计量资料统计分析应用t检验,计数资料统计分析应用卡方检验,检验水准设α=0.05。结果SBT+NiCCI组和SBT组患者入组时基础情况年龄、性别、氧合指数和APACHEⅡ评分对比差异无统计学意义(P>0.05);SBT+NiCCI组和SBT组主要指标撤机成功率分别为91.60%和75.00%,平均撤机时间分别为(4.78±1.70)d和(6.27±2.19)d,两组差异均有统计学意义(P<0.05);两组次要指标平均住院时间分别为(11.52±2.29)d和(13.63±2.63)d,28 d病死率分别为4.17%和20.00%,两组差异均有统计学意义(P<0.05)。结论自主呼吸试验联合无创连续心脏指数监测改善机械通气撤机效果,有助于改善患者预后。

Objective To investigate the effect of spontaneous breathing trial(SBT)combined with non-invasive continuous cardiac index monitoring(NiCCI)on ventilator weaning and prognosis.Methods From October 2017 to March 2019,totally 44 patients with respiratory failure who were admitted to Respiratory Critical Care Unit and Respiratory Sub-critical Care Unit in our hospital were randomly divided into two groups:combined monitoring(SBT+NiCCI)group and control(SBT)group.Patients in both groups passed weaning screening.Patients in SBT group were weaned when passed SBT,and patients in SBT+NiCCI group were weaned when passed SBT and their continuous cardiac indexes were above 2.6 L/min/m^2.The weaning success rate and average weaning time were selected as the main observation indicators.The average hospitalization stay and 28-day mortality rate were used as secondary observation indicators to evaluate the effect of SBT combined with NiCCI monitoring on mechanical ventilation and prognosis.The software SPSS 25.0 was used for statistical analysis.The statistical analysis of measuring data was applied by t test.The statistical analysis of counting data was applied by chi-square test.The test level was set asα=0.05.Results The age,sex,oxygenation index and APACHEⅡscores of two groups were similar(P>0.05).The weaning success rate in SBT+NiCCI group and SBT group was 91.6%and 75%,respectively,while the mean weaning time was(4.78±1.70)days and(6.27±2.19)days,respectively,and the differences between two groups were statistically significant(P<0.05).The average hospitalization stay was(11.52±2.29)days and(13.63±2.63)days,respectively,while the 28 day mortality rate was 4.17%and 20%,respectively,and the difference was statistically significant(P<0.05).Conclusion The spontaneous breathing trial combined with non-invasive continuous cardiac index monitoring improves effect of weaning from mechanical ventilation,which also helps to improve clinic prognosis of patients.