一项关于自主呼吸试验方法选择的观察性研究

An Observational Study on the Choice of Spontaneous Breathing Test Method

目的:观察与研究对于一些不能耐受T管试验2h的有创机械通气患者,随后通过了低水平PSV试验后是否能够拔管撤机。方法:选取2017年3月—2018年9月收治的华中科技大学同济医学院附属协和医院呼吸与危重症医学科,并经口气管插管且机械通气大于24h的患者作为研究对象。当患者首次通过自主呼吸试验(SBT)试验前评估后即开始行T管试验2h,患者通过该试验后立即给予拔管撤机,若不通过,则继续给予低水平压力支持通气(PSV)试验30min,患者通过后给予拔管撤机,若不通过,恢复SBT试验前机械通气参数继续治疗。观察两组患者SBT通过率,再插管率和病死率。结果:共招募了122例通过了SBT试验前评估的患者并进行了首次的T管试验,其中88例患者通过了该试验评估并拔除了气管插管。另外34例患者首次T管试验失败,给予了进一步的低水平PSV试验,其中22例患者通过了该试验评估并拔除了气管插管。两组患者在48h内再插管率上差异无统计学意义[T管组(12/88=14%)VS低水平PSV组(4/22=18%)]。在病死率上,T管组(5/88=6%)VS低水平PSV组(2/22=9%)。结论:在SBT评估中,对患者呼吸功能要求相对较低的PSV试验方法并仅持续评估30min,相较于对患者呼吸功能要求较高的T管试验方法持续评估2h,前者有更高的SBT成功率且不会导致再插管率和病死率的增加。

Objective:To observe and study whether some patients with invasive mechanical ventilation who cannot tolerate the T-tube test for 2 hours can be extubated and weaned after passing the low-level PSV test.Methods:Patients who were admitted to the hospital from March 2017 to September 2018 and were intubated through the mouth and had mechanical ventilation for more than 24 h were selected.The T-tube test was started 2 h after the patient passed the pre-SBT test for the first time,and the pa­tients were extubated and weaned immediately after passing the test.If the patients failed,the low-level PSV test continued for 30 min,and the patients were extubated and weaned after passing.If the patients failed,the mechanical ventilation parameters be­fore the SBT test were restored and continued to be treated.The SBT passing rate,reintubation rate and mortality rate were ob­served in the two groups.Results:A total of 122 patients who passed the pre-SBT trial evaluation were recruited and the first T-tube trial was conducted.88 of them passed the trial evaluation and the tracheal intubation was removed.Another 34 patients failed the first T-tube test and were given a further low-level PSV test,of which 22 patients passed the test and the tracheal intu­bation was removed.There was no statistically significant difference in the reintubation rate within 48 h between the two groups.The T tube group(12/88=14%)was lower than the low-level PSV group(4/22=18%).There was no statistical difference in the mor­tality rate,the T tube group(5/88=6%)was lower than the low-level PSV group(2/22=9%).Conclusion:In SBT evaluation,the PSV test method,which requires relatively low patient respiratory function,only lasts for 30 min.Compared with the T tube test method,which requires higher patient respiratory function,lasts for 2 h,the former has higher SBT.The success rate will not lead to an increase in the reintubation rate and mortality rate.