机械通气撤机指征的临床分析

The Clinical Study of Mechanical Ventilator Weaning

目的:研究呼吸衰竭患者撤机困难的主要因素,探讨无血气及血流动力学监测下机械通气撤机的指征,从而指导早期成功撤机。方法:对呼吸衰竭机械通气的24例患者进行撤机,根据成败判定标准,分为撤机成功组（17例）与失败组（7例）,对两组撤机参数进行对比分析。结果:两组患者的急性生理慢性健康评分Ⅱ（A PACHEⅡ）、血氧饱和度均无明显差异（P】0.05）。成功组患者的气管插管通气时间、浅快呼吸指数（f/VT）分别为:（5±2）天、（68±26）min-1.L-1次-1;失败组患者分别为:（15±5）天、（109±23）min-1.L-1次-1,两组结果对比有显著差异性（P【0.05）。结论:呼吸衰竭者撤机困难的重要原因是呼吸肌疲乏,浅快呼吸指数（f/VT）可以作为预测能否脱机的指征。

Objective:To study the primary factors which effect on the mechanical ventilator weaning in the respiratory failure patients .To research the indication of mechanical ventilator weaning without Blood-Gas analysis or hemodynamic monitoring, which can be a guide to a success early mechanical ventilator weaning.Methods:To separate the 24 respiratory failure patients requiring mechanical ventilation into two groups according to the success of mechanical ventilator weaning or not.Compare the success group(17patients)with the failure group(7patients)by the parameters.Results:No significant difference was found(P>0.05)by comparing two groups in Acute Physiology and Chronic Health EvaluationⅡScore System(A PACHEⅡ)and the oxygen saturation of blood.In success group,the time of trachea cannula is(5±2)days and the Rapid Shallow Breath Index(f/VT) is(68±26)min^(-1).L^(-1)次^(-1),and in the failure group is(15±5)days、(109±23)min^(-1).L^(-1)次^(-1).Two groups are significant difference(P<0.05).Conclusion:The primary difficulty of the mechanical ventilator weaning in respiratory failure patients is respiratory muscle fatigue.The Rapid Shallow Breath Index(f/VT)can be an indicator to estimate a success mechanical ventilator weaning.