慢性阻塞性肺疾病患者长期机械通气撤机困难的临床分析

Clinical analysis of 24 difficult-weaning COPD patients by long-term mechanical ventilation

目的 分析长期机械通气撤机困难的慢性阻塞性肺疾病 (COPD)患者撤机成败的因素。方法 2 4例COPD伴Ⅱ型呼吸衰竭气管插管机械通气 >3d ,平均 ( 15 .3± 9.6)d。其中脱机成功组 :17例 ,失败组 :7例 ;监测并比较分析两组患者的一般情况、气管插管、机械通气时间、动脉血气分析、肺功能及呼吸力学的变化情况。结果 两组患者的血气分析、急性生理慢性健康评分 (APACHEⅡ )、氧合指数、气道阻力均无差异 (P >0 .0 5 )。成功组患者的气管插管、机械通气时间、呼吸浅快指数 (f VT)、最大吸气负压 (MIP)和内源性呼气末正压 (PEEPi)分别为 ( 6± 2 )d、( 70± 2 5 )min- 1 ·L- 1 ·次 - 1 、( -2 2± 3 )cmH2 O和 ( 6± 2 )cmH2 O ;失败组患者分别为 ( 16± 5 )d、( 110± 2 2 )min- 1 ·L- 1 ·次 - 1 、( -12± 3 )cmH2 O和 ( 11± 3 )cmH2 O ,两组结果比较差异有显著性 (P <0 .0 5 )。结论 COPD呼吸衰竭长期机械通气患者 ,决定脱机是否成功与气管插管、机械通气时间长短、呼吸肌泵功能指标优劣、呼吸肌储备能力强弱有显著的关系 ,应着力于解决 ,提高脱机成功率。

Objective To analyze the clinical data of 24 difficult weaning cases by long term mechanical ventilation in intubated chronic obstructive pulmonary disease (COPD),and to investigate the successful weaning factors.Methods 24 COPD patients combined with hypercapnic respiratory failure who received mechanical ventilation over 72 h were divided into two groups.17 patients in group A were successful in weaning,however 7 patients in group B failed.The general condition,intubated and ventilated time,arterial blood gas analysis(ABGs),pulmonary function test and respiratory mechanics were monitored and measured respectively.Results There were no significant difference in ABGs,APACHEⅡ,oxygenation index (OX) and airway resistance(P>0.05).There were significant differences in the following parametes between two groups:intubated and mechanical time (6±2)d vs (16±5)d;rapid shallow breath index (RSBI,f/V T),(70±25)times·min -1 ·L -1 vs (110±22)times·min -1 ·L -1 );maximal inspiratory pressure (Pimax),(-22±3)cm H 2O vs (-12±3)cm H 2O;intrinsic positive end expiratory pressure (PEEPi),(6±2)cm H 2O vs (11±3)cm H 2O(P<0.05).Conclusion Whether the mechanical ventilator weaning is successful or not for the COPD patients combined with respiratory failure who underwent intubation and long term mechanical ventilation depends on the intubated and ventilated time,the pump function and reserved capacity of respiratory muscles.