自主呼吸试验持续时间对慢性阻塞性肺疾病急性加重患者有创通气撤离的影响  

Effect of spontaneous breathing trial with different durations on the outcome of weaning from invasive positive pressure ventilation in the patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：罗祖金[1] 詹庆元[1] 孙兵[1] 李洁[1] 夏金根[1] 姚秀丽[1] 童朝晖[1] 任雁宏[1] 

机构地区：[1]首都医科大学附属北京朝阳医院-北京呼吸疾病研究所,北京100020

出　　处：《中国急救医学》2009年第4期289-292,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的比较30min和120min的自主呼吸试验（SBT）持续时间对慢性阻塞性肺疾病急性加重（AECOPD）患者有创通气撤离的影响。方法回顾性收集接受经口气管插管并行有创通气的AECOPD患者应用SBT的临床资料，根据试验持续时间不同将患者分为30min组和120min组。比较两组患者的基础情况、各项试验前评价指标、试验成功率以及两组试验成功者48h重新插管率、有创通气和机械通气时间、住重症监护室（ICU）和住院时间、呼吸机相关肺炎（VAP）发生率和院内病死率。结果收集90例患者资料，30min组42例，120min组48例。两组基础情况和试验前评价指标相仿；两组试验时压力支持水平（△PS）分别为（7．8±1．2）cmH2O和（7．7±1．0）cmH2O；两组试验成功率分别为69．0％和66．7％；两组试验成功者48h重新插管率分别为6．9％和3．1％，有创通气时间分别为（6．6±4．9）d和（9．3±7．5）d，机械通气时间分别为（11．6±5．8）d和（12．6±7．8）d，住ICU时间分别为（11.4±7．1）d和（14.9±9．2）d，住院时间分别为（25．8±14．2）d和（26．7±11．6）d，VAP发生率分别为3．4％和9．4％，院内病死率分别为10．3％和3．1％。以上各项指标比较差异均无统计学意义（P〉0．05）。结论对于SBT成功的AECOPD患者，30min和120min对有创通气撤离的影响相似，对AECOPD患者进行SBT，30min可考虑作为常规的试验持续时间。Objective To investigate effect of spontaneous breathing trial （SBT） with target durations of 30min and 120min on the outcome of weaning from invasive positive pressure ventilation （ IPPV ） in the patients with acute exacerbation of chronic obstructive pulmonary disease （ AECOPD ）. Methods The clinical data concerning the application of SBT in the patients with AECOPD who received orotracheal intubation and IPPV were analyzed retrospectively. According to different durations of SBT, patients were assigned into 30min group or 120min group. Characteristics, readiness to wean and percentage of patients who successfully completed SBT were compared between 30min group and 120min group. Reintubation rates within 48h after extubation, durations of IPPV and mechanical ventilation （ MV）, the days in intensive care unit （ ICU ） and hospital, VAP rates and in - hospital mortality rates were compared between patients who successfully completed SBT in 30 min group and those in 120min group. Results 90 patients were enrolled. 30 min group （ n = 42 ） and 120rain group （ n = 48 ） had similar characteristics, readiness to wean, levels of pressure support during SBT[ 17.8 ± 1.2 ） cm H2 O, （ 7.7 ± 1.0 ） cm H2 O, P 〉 0.05 ）, and percentage of patients who completed SBT（ 69.0%, 66.7%, P 〉 0.05）. No statistically significant differences were observed in reintubation rates within 48h after extubation （6.9%, 3.1%, P 〉0.05）,durations of IPPV [ （ 6.6 ± 4.9 ） d, （ 9.3 ± 7.5 ） d, P 〉 0.05 ], durations of MV [ （ 11.6 ± 5.8 ） d, （ 12.6 ± 7.8）d, P〉0.05], the days in ICU[（11.4±7.1）d,（14.9±9.2）d, P〉0.05], the days in hospital [ （25.8 ± 14.2） d,（26.7 ±11.6）d, P〉0.05], VAP rates （3.4%, 9.4%, P 〉0.05） and in - hospital mortality rates （ 10.3% , 3.1% , P 〉 0.05 ） between patients who successfully completed SBT in 30 min group and those in 120 min group. Conclusions SBT with duration of 30 min is as effective in the successfully extubated A

关 键 词：慢性阻塞性肺疾病 正压呼吸 撤机 自主呼吸试验 

分 类 号：R563[医药卫生—呼吸系统]