智能化撤机和经验性撤机的前瞻性随机对照研究  

Comparison of computer-driven weaning and physician-directed weaning from mechanical ventilation： a randomized prospective study

作　　者：马玉杰[1] 杨晓军[1] 曹相原[1] 马希刚[1] 

机构地区：[1]宁夏医科大学附属医院ICU科,银川750004

出　　处：《中华结核和呼吸杂志》2010年第3期174-178,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的比较智能化撤机和经验性撤机两种撤机方法对机械通气撤机困难患者的疗效。方法采用前瞻性随机对照研究，按平衡指数最小的原则进行简易的临床试验随机化分组，将62例综合ICU内的撤机困难患者随机分人智能化SmartCare组（SC组，30例）和同步间歇指令通气联合压力支持通气组（SP组，32例）进行撤机试验，两组患者的疾病构成、年龄、性别、人ICU时急性生理慢性健康状况评分（APACHE）Ⅱ以及撤机前机械通气时间差异均无统计学意义。两组患者除撤机方法不同外，其他处理均相同，观察两组的撤机时间、再插管率和机械通气相关并发症的发生率以及ICU滞留率。结果SC组神经肌肉病变患者、术后呼吸支持患者和呼吸系统疾病患者的撤机时间分别为（49±13）、（67±37）和（254±96）h，明显少于SP组[分别为（223±38）、（106±34）和（502±91）h，χ2值分别为8，33、4．77和4．43，均P〈0.05]。SC组神经肌肉病变患者、术后呼吸支持患者的ICU滞留时间分别为（9．0±1.7）和（7．3±1．9）d，明显低于SP组的（20．8±5．1）和（14．6±1．7）d（χ2值分别为6．74和7．68，均P〈0．05）。SC组平均调节呼吸机次数为（5±1）次／人明显低于sP组的（13±3）次／人（t=2．73，P〈0．05）。两组的再插管率、气管切开率、气胸发生率、呼吸机相关性肺炎（VAP）发生率和皮下气肿发生率比较差异均无统计学意义。结论CDW智能化撤机法应用于撤机困难患者能够有效地缩短撤机时间，减少ICU滞留时间，并可以减少医生调节呼吸机的负担而节约医疗资源。Objective To evaluate if the computer-driven weaning （CDW） with a closed-loop knowledge-based system introduced in a ventilator is superior to physician-directed weaning （PDW） in diffficult-to-wean patients in the intensive care unit （ICU）. Methods Sixty-two difficult-to-wean patients were randomized into 2 groups ： weaning with Smart Care/PS （ SC group, n = 32） or with synchronize intermittent mandatory ventilation add positive support ventilation （ SP group, n = 30）. In the SC group, the automated system titrated pressure support, conducted a spontaneous breathing trial and provided notification of success （separation potential）. In the SP group, weaning from ventilators was carried out by gradually decreasing respiratory support. The length of mechanical ventilation and stay in ICU, the rate of ventilatorassociated pneumonia （VAP）, the retubing rate in 48 h, manual ventilator setting changes before extubation were compared between the 2 groups. Results In the SC group, the weaning time was （49 ± 13 ） h, （67 ± 37） h, and （254 ± 96 ） h, respectively in patients with neuromuscular diseases, for post-operative respiratory support and patients with respiratory diseases; while in the SP group, the weaning time was （223 ± 38） h, （ 106 ± 34） h and （502 ± 91 ） h, respectively; the difference between the 2 groups being statistically significant （ χ2 = 8.33, 4.77, 4.43, all P 〈 0.05 ）. The time of stay in ICU was （9.0 ± 1.7 ） d and （7.3 ± 1.9） d in the SC group for patients with neuromuscular diseases and patients with post-operative respiratory support, respectively, while that was （20.8 ± 5.1 ） d and （ 14.6 ± 1.7 ） d in the SP group, respectively. Time of stay in ICU was significantly shorter in the SC group （ χ2 = 6.74, 7.68, both P 〈 0.05 ）. The number of manual ventilator setting changes was （ 5 ± 1 ） times in the SC group, significantly less than that of the SP group （13 ±3, t = 2.73, P 〈 0.05 ）. There were no

关 键 词：通气机撤除法 人工智能 呼吸 人工 

分 类 号：R459.7[医药卫生—急诊医学]