呼吸机脱机指数在严重创伤治疗中的可行性研究  

Feasibility study on index of ventilator weaning in treatment of severe trauma

作　　者：吴恒义[1] 池丽庄[1] 顾葆春[1] 邢锐[1] 郭振辉[1] 杨自力[1] 杨春华[1] 

机构地区：[1]广州军区广州总医院,广东广州510010

出　　处：《创伤外科杂志》2005年第1期36-38,共3页Journal of Traumatic Surgery

摘　　要：目的　探讨严重创伤病人脱离呼吸机的要素。方法　总结 6 17例行呼吸机治疗的创伤病人临床资料 ,分析与脱机关系密切的 14种因素 ,提出“脱机指数”的概念和相应的计分法。结果　脱机指数分值越高 ,伤情越重 ,脱机越困难。如严重颅脑外伤脱机指数均值 4 3.84分 ,脱机成功率 5 1.5 5 % ;多器官功能障碍综合征 (MODS)均值 2 5 .16分 ,脱机成功率 5 5 .74 % ;心肺脑复苏均值 33.12分 ,脱机成功率 6 2 .12 %。以上脱机成功率不高 ,而脱机指数均值 <2 0的急性呼吸衰竭和严重胸部创伤 ,其脱机成功率高达 90 %以上。结论　“脱机指数”准确表述了与脱机有关的各种密切因素 ,伤后肺部情况 ,如潮气量、最大吸气压、氧合指数、PaCO2 、自主呼吸频率等仍然是预示能否脱机的决定性因素。脱机指数计分法是一种简便、可信、实用的方法 ,具有现实的指导意义。Objective To find the significant factors on weaning from mechanical ventilation in patients with severe trauma.Methods Clinical data of 617 patients with severe trauma under mechanical ventilation were reviewed,and relationship between weaning from ventilation and 14 factors were analyzed.A comprehensive weaning index and the method of its scoring were proposed.Results The mean weaning index in the group with severe craniocerebral injury was 43.84,25.16 in the group with MODS and 33.12 in the group with recovery of heart,lung and brain function;their successful weaning rates was 51.55%,55.74% and 62.12% respectively.Whereas the successful weaning rate was higher than 90% in the group with acute respiratory failure and severe thoracic injury,their weaning indexes were lower than 20.Conclusion Weaning index states various factors closely related with weaning from mechanical ventilation,among which the state of lung after injury,such as tidal volume,maximal inspiration pressure,oxygenation index,PaCO 2 and autonomic breath frequency are still decisive factors.The scoring method of the weaning index is simple,reliable,practical and of guiding significance.

关 键 词：呼吸机 脱机指数 创伤 

分 类 号：R641[医药卫生—外科学]