呼吸衰竭脱机拔管困难患者脱机方法的探讨

Discussion of offline methods for patients with respiratory failure and difficulty in extubation

目的探讨右心功能监测、呼吸康复训练、针灸治疗在呼吸衰竭(呼衰)脱机拔管困难患者脱机治疗中的临床意义。方法选择在甘肃中医药大学第三附属医院(白银市第一人民医院)重症医学科住院的呼衰行呼吸机辅助通气治疗后脱机拔管困难82例患者作为研究对象。根据右心功能监测结果,给予呼吸康复训练、针灸治疗进行脱机拔管的42例患者作为观察组;另40例采用常规对症支持治疗的患者作为对照组。比较两组患者脱机成功率、28 d呼衰复发率、3个月内病死率、肺部感染发生率、右心衰竭发生率,以及实验室指标白细胞计数(WBC)、中性粒细胞比例、C-反应蛋白(CRP)、降钙素原(PCT)、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))的差异。结果与对照组比较,观察组脱机成功率明显升高〔57.1%(24/42)比35.0%(14/40)〕,28 d呼衰复发率、3个月病死率、肺部感染发生率、右心衰竭发生率和实验室指标WBC、中性粒细胞比例、CRP、PCT、PaCO_(2)水平均明显降低〔28 d呼衰复发率:23.8%(10/42)比45.0%(18/40),3个月内病死率:28.6%(12/42)比50.0%(20/40),肺部感染发生率:23.8%(10/42)比45.0%(18/40),右心衰竭发生率:14.3%(6/42)比35.0%(14/40),WBC(×109/L):8.10±4.34比17.09±8.23,中性粒细胞比例:0.761±0.124比0.878±0.060,CRP(mg/L):25.2±8.9比148.3±78.3,PCT(g/L):1.79±3.31比9.26±11.58,PaCO_(2)(mmHg,1 mmHg≈0.133 kPa):37.95±5.54比48.88±5.39,均P<0.05〕,PaO_(2)明显升高(mmHg:93.12±2.88比85.50±4.22,P<0.05)。结论根据右心功能监测结果进行脱机拔管,并给予呼吸康复训练、针灸治疗能明显提高呼衰脱机拔管困难患者脱机拔管成功率,临床疗效肯定。

Objective To explore the clinical significance of right heart function monitoring,respiratory rehabilitation training,and acupuncture therapy in the offline treatment of the patients with respiratory failure and offline extubation difficulties.Methods A total of 82 patients with difficulty in extubation after ventilator assisted ventilation for respiratory failure who were hospitalized in the department of critical care medicine of the Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine(the First People's Hospital of Baiyin City)were selected as observation objects.According to the results of right heart function monitoring,of the above 82 patients,42 with offline extubation difficulties given respiratory re-habilitation training and acupuncture therapy to carry out offline extubation were included into the observation group,and another 40 patients treated with conventional therapy and symptomatic supportive treatment for weaning extubation were assigned in the control group.The differences of the offline success rate,the 28-day recurrence incidence of acute respiratory failure,mortality within 3 months,the incidences of lung infection and right heart failure,and the laboratory indicators such as white blood cells count(WBC),neutrophil percentage,C-reactive protein(CRP),procalcitonin(PCT),arterial partial pressure of carbon dioxide(PaCO_(2))and arterial partial pressure of oxygen(PaO_(2))in the two groups were compared.Results Compared with the control group,the offline success rate was significantly increased in the observation group[57.1%(24/42)vs.35.0%(14/40)],while the incidence of reccurence of acute respiratory failure within 28 days,mortality within 3 months,the incidences of lung infection and right heart failure,and laboratory indicators WBC,neutrophil percentage,CRP,PCT,PaCO_(2) in the observation group were significantly reduced[28-day rate of recurrence of respiratory failure:23.8%(10/42)vs.45.0%(18/40),mortality within 3 months:28.6%(12/42)vs.50.0%(20/40),incidence of lung infection:23.8%(10/42)比45.0%(18/40),incidence of right heart failure:14.3%(6/42)vs.35.0%(14/40),WBC(×109/L):8.10±4.34 vs.17.09±8.23,neutrophil percentage:0.761±0.124 vs.0.878±0.060,CRP(mg/L):25.2±8.9 vs.148.3±78.3,PCT(g/L):1.79±3.31 vs.9.26±11.58,PaCO_(2)(mmHg,1 mmHg≈0.133 kPa):37.95±5.5 vs.48.88±5.39,all P<0.05],PaO_(2) was obviously increased(mmHg:93.12±2.88 vs.85.50±4.22,P<0.05).Conclusion According to the results of right heart function monitoring to carry out offline extubation,applying respiratory rehabilitation training and acupuncture treatment can significantly elevate the success rate of offline extubation in patients with respiratory failure and offline extubation difficulty,and the clinical efficacy is affirmative.