气道阻力和静态肺顺应性测定在重型颅脑损伤患者脱机筛查中的应用研究

Airway resistance and static lung compliance determination application offline screening for patients with severe craniocerebral injury

目的机械通气延迟脱机和困难脱机是重型颅脑损伤患者治疗中的难点,本文旨在通过分析气道阻力和静态肺顺应测定在呼吸机脱机筛查中的应用价值,缩短此类患者的机械通气时间。方法选取亳州市人民医院重症医学科一病区2023年1—11月收治的重型颅脑损伤患者78例,使用随机数字表法将患者分为实验组(39例)和对照组(39例),所有患者均予以脱水降颅压、维持脑灌注、雾化祛痰、镇静镇痛、营养支持等治疗。对照组依据传统脱机筛查方法实行呼吸机脱机,实验组在气道阻力(Raw)≤10 cmH_(2)O·L^(-1)·s^(-1),静态肺顺应性≥40 mL/cmH_(2)O基础上应用传统呼吸机脱机筛查方法实行呼吸机脱机,比较2组ICU住院时间、呼吸机使用时间、自主呼吸试验(SBT)次数、48 h呼吸机再次上机率、呼吸机相关性肺炎(VAP)发生率、住院总时间、医疗总花费。结果实验组ICU住院时间为11(6,16)d,短于对照组[13(15,19)d,P<0.05];实验组呼吸机通气时间为141(46,230)h,短于对照组[212(151,254)h,P<0.05];实验组SBT次数少于对照组[1(1,1)次vs.2(1,3)次,P<0.05];实验组住院总时间短于对照组[29(20,44)d vs.41(32,62)d,P<0.05];实验组医疗总花费、VAP发生率和48 h再上机率均小于对照组(P<0.05)。结论气道阻力和肺顺应性测定联合传统呼吸机脱机筛查方法更有利于重型颅脑损伤患者呼吸机脱机,缩短呼吸机使用时间和ICU住院时间,降低医疗花费及VAP的发生率。

Objective Delayed weaning and difficult weaning of mechanical ventilation are the difficulties in the treatment of patients with severe craniocerebral injury.This paper aims to shorten the mechanical ventilation time of such patients by analyzing the application value of airway resistance and static lung compliance in ventilator offline screening.Methods Seventy-eight patients with severe craniocerebral injury admitted to the First Ward of ICU at Bozhou People's Hospital from January 2023 to November 2023 were selected and randomly divided into an experimental group(n=39)and a control group(n=39).All patients received dehydration therapy to reduce intracranial pressure,maintain cerebral perfusion,nutritional support,aerosol expectoration,sedation and analgesia,as well as other treatments.The control group underwent traditional ventilator weaning screening method while the experimental group underwent traditional ventilator weaning screening method based on airway resistance(Raw)≤10 cmH_(2)O·L^(-1)·s^(-1) and static lung compliance≥40 mL/cmH_(2)O.The ICU length of stay,ventilator duration,number of spontaneous breathing trial,48 h ventilator re-up rate,incidence of ventilator-associated pneumonia(VAP),total length of hospitalization,and total healthcare expenditure were compared between the two groups.Results The length of ICU stay was 11(6,16)days in the experimental group,which was shorter than that in the control group[13(15,19)days,P<0.05].The duration of mechanical ventilation was 141(46,230)hours in the experimental group,which was shorter than that in the control group[212(151,254)hours,P<0.05].The number of spontaneous breathing trials(SBT)in the experimental group was less than that in the control group[1(1,1)vs.2(1,3),P<0.05].The total length of hospital stays of the experimental group was shorter than that of the control group[29(20,44)d vs.41(32,62)d,P<0.05].Additionally,there were lower total medical costs as well as reduced incidence rates of VAP,and re-hospitalization within 48 hours observed among patients from the experimental group compared to those from the control group(P<0.05).Conclusion Airway resistance and lung compliance measurement combined with traditional ventilator weaning screening method is more conducive to ventilator weaning in patients with severe craniocerebral injury,shortening the duration of ventilator use and ICU stay,and reducing the total length of hospital stay and medical costs,and reduce the incidence of VAP.