浅快呼吸指数和呼吸功对撤机指导作用  

Study of rapid-shallow-breathing index and work of breathing as weaning parameters in mechanically ventilated patients

作　　者：孙师元[1] 杜立峰[1] 党晓燕[1] 

机构地区：[1]西安交通大学第二临床医院急诊科,西安710004

出　　处：《山西医科大学学报》2006年第7期730-731,共2页Journal of Shanxi Medical University

摘　　要：目的研究浅快呼吸指数(f/VT)和呼吸功(WOB)对机械通气患者撤机的指导作用。方法选择机械通气并准备撤机23例慢性阻塞性肺部疾病患者,应用BICORE-CP100呼吸监测仪床边监测病人f/VT、WOB、潮气量(VT)、呼吸频率(RR)、每分钟通气量(MV)、最大吸气压(MIP)、氧合指数(PaO2/FiO2)及APACHⅡ评分,并将浅快呼吸指数、呼吸功值和常规撤机指标及APACHⅡ评分相互比较,观察其对撤机的指导意义。结果撤机成功16例,其中14例f/VT值≤100 bpm/L,2例f/VT值>100 bpm/L;12例WOB值<0.75 J/L,4例WOB在0.93-1.37 J/L之间。撤机失败7例中,1例f/VT值≤100 bpm/L,6例f/VT值>100 bpm/L;7例WOB>(1.86±0.51)J/L。撤机组f/VT、WOB于成功组相互比较有显著差异(P<0.05)。结论f/VT、WOB对撤机都有重要指导作用,但并非敏感指标,应考虑肺部基础疾病,结合临床综合指标更为可靠。Objective To evaluate the rapid-shallow-breathing index （RVR or f/VT） and work of breathing （WOB） as predictive parameters of weaning in patients with mechanical ventilation. Methods f/VT, WOB, standard weaning criteria （respiratory rate, tidal volume, ventilation volume per minute, maximal inspiratory pressure, arterial partial pressure of oxygen/fractional concentration of O2 in inspired gas） and APACHH score were observed and compared between the succeed and the failed. Results The weaning in 16 cases succeed. Of them, f/VT≤100 bpm/L was in 14 case, f/VT 〉 100 bpm/L was in 6 cases; WOB≤0.75 J/L was in 12 cases, 0, 93 - 1.37 J/L in 4 cases. The weaning in 7 cases failed, Of them, f/VT≤100 bpm/L was in 1 case; WOB〉 （1.86 ± 0.51）J/L was in 7 cases, f/VT,WOB were statistically significantly different （0.01 〈 P〈 0.05） between the succeed and the failed. Conclusion The results suggest that f/VT and WOB are important to make a decision of weaning, but they are not sensitive indexes. If combined with the relevant clinical signs and basic pulmonary conditions, it will be better to indicate the weaning.

关 键 词：浅快呼吸指数 呼吸功 机械通气 撤机 

分 类 号：R605.97[医药卫生—急诊医学]