电脑智能脱机对慢性阻塞性肺疾病脱机的影响  

Impact of a computer-driven knowledge-based system of SmartCare on weaning patients with chronic obstructive pulmonary diseases detached from mechanical ventilation

作　　者：徐晓婷[1] 刘玲[1] 杨毅[1] 黄英姿[1] 刘松桥[1] 杨从山[1] 邱海波[1] 

机构地区：[1]东南大学附属中大医院重症医学科,南京210009

出　　处：《中华急诊医学杂志》2012年第6期602-606,共5页Chinese Journal of Emergency Medicine

基　　金：江苏省科技发展计划（BS2007045：）;江苏省自然科学基金项目（BK2008298）

摘　　要：目的比较电脑智能脱机、自主呼吸试验（SBT）和经验脱机3种脱机方法对慢性阻塞性肺疾病患者脱机时间和脱机成功率的影响。方法前瞻性临床研究，2005年3月至2008年5月间东南大学附属中大医院68例收住重症医学科（ICU）的COPD机械通气患者纳入观察。随机（随机数字法）分为电脑智能组（24例）、SBT组（24例）和经验组（20例）进行脱机。记录每位患者的脱机时间、总机械通气时间、ICU住院时间以及脱机成功率、住院生存率和机械通气的相关并发症。脱机成功标准为脱机拔管48h以上未再插管进行机械通气。结果电脑智能组的脱机时间和总机械通气时间均明显低于经验组（P=0．002，0．002），但与SBT组比较差异无统计学意义（P=0．540，0．573）。SBT组ICU住院时间（7．5d）明显短于经验组（82．5d）（P=0．015），但SBT组和电脑智能组（8．0d）以及经验组和电脑智能组比较ICU住院时间差异无统计学意义（P〉0．05）。电脑智能组脱机成功率为88．3％，明显高于经验组（50．0％）（P=0．02），但与SBT组（66．7％）比较差异无统计学意义（P〉0．05）。ICU住院生存率和总住院生存率3组间比较差异无统计学意义（P〉0．05），再插管率、自行拔管率和无创呼吸机辅助通气率三组间差异亦差异无统计学意义（P〉0．05）。结论电脑智能脱机法较经验法能明显提高脱机成功率，但与SBT法相比无优势。Objective To compare the outcomes of 3 modes of weaning, e. g. SmartCare （ a computer- driven knowledge-based system）, spontaneous breathing trials （SBT） and empirical methods, used in patients with chronic obstructive pulmonary diseases （COPD） weaned off mechanical ventilation. Methods Sixty-eight COPD patients were enrolled and randomly （random number） assigned to receive SmartCare （ SC group, n = 24）, SBT （SBT group, n =24） or empirical methods （EM group, n =20）. The following data were recorded including beginning of weaning： time consumed for weaning, duration of mechanical ventilation, length of ICU stay, success rate of weaning, survival rate during hospitalization and the complications of mechanical ventilation. The patients were considered as successfully weaned when they were able to tolerate at least 48 consecutive hours of spontaneous breathing. Results Time required for weaning and total time for mechanical ventilation in SC group were greatly shorter than those in EM group （P =0.1302, 0. 002）, but there were no differences between SC group and SBT group （P = 0. 540, 0. 573 ）. Though the length of ICU stay （7. 5 d） in SBT group was notably shorter than that in EM group （82. 5 d） （P =0. 015）, there was no difference between SBT group and SC group （8. 0 d）. Weaning success rate was greater in the SC group （88. 3% ） than that in EM group （50. 0% ）, but there was no difference between SBT group （66. 7% ） and SC group. No significant differences in survival rate during hospitalization, rate of re-intubation, self-extubation and need for noninvasive ventilation were found among three groups. Conclusions Compared to empirical methods for weaning, SmartCare could greatly increase the success rate of weaning, but it was not superior to SBT.

关 键 词：肺疾病 慢性阻塞性 通气机撤除法 智能 呼吸 机械通气 脱机 脱机方案 

分 类 号：R563.9[医药卫生—呼吸系统]