呼吸功对机械通气患者撤机的指导作用

Work of breathing as a weaning parameter in mechanically ventilated patients

目的 研究呼吸功 (WOB)对机械通气患者撤机的指导意义。方法 选择机械通气并准备撤机的患者 14例 ,应用BI CORE -CP10 0呼吸监测仪床边监测病人WOB和常规撤机指标 [潮气量 (VT)、呼吸频率 (RR)、每分钟通气量 (VE)、最大吸气压 (MIP) ],氧合指数 (PaO2 /FiO2 ) ,及APACHⅡ评分 ,观察撤机成功与失败组呼吸功值和常规撤机指标、PaO2 /FiO2 、APACHⅡ评分相互比较。结果 12例撤机成功 ,其中 4例WOB正常 (<0 .75J/L) ,8例WOB升高 (0 .93～ 1.37J/L)。 2例撤机失败(>1.92～ 2 .4 7J/L) ,WOB、RR、MEP、VE、PaO2 /FiO2 、APACHⅡ评分 ,均明显高于成功组 (P <0 .0 5 ) ,VT 明显低于成功组 (P<0 .0 5 )。结论 WOB对撤机有指导作用 ,但并非敏感指标 ,应考虑肺部基础疾病 。

Objective To evaluate the work of breathing (WOB) as a predictive measure of weaning in patients with mechanical ventilation. Methods WOB and standard weaning criteria(respiratory rate,tidal volume,ventilation volume perminute,maximal inspiratory pressure arterial partial pressure of oxygen/fractional concentration of O 2 in inspired gas) and APACHⅡ scoring were observed and compared between the succeeding groups and failed groups. Results Twelve cases succeeded, of which in 4 WOB was normal(<0.75 J/L),in 8 WOB rose(0.93～13.7J/L).Two cases failed[>(1.92±0.47)J/L]. WOB, RR, MIP, VE, PaO 2/FiO 2 and APACHⅡ scoring were significantly higher in failed groups than that in successful groups (P<0.05). V T was significantly lower than in successful groups (P<0.05).Conclusion WOB alone is inadequate as atwearing indicator. It is necessary to make a decision of weaning by WOB,relevant clinical signs and basic pulmonary conditions.