动脉血氧合指数变化对重症困难脱机患者脱机结果的预测价值  

Predictive value of arterial blood oxygenation index changes for wean results in severe difficult weaning patients

作　　者：常永梅[1] 孙聪[1] 

机构地区：[1]广东省第二人民医院呼吸内科,510317

出　　处：《中国现代药物应用》2015年第7期16-17,共2页Chinese Journal of Modern Drug Application

摘　　要：目的探讨动脉血氧合指数(Pa O2/Fi O2)变化对困难脱机患者拔管失败的预测价值。方法机械通气超过48 h的困难脱机患者中成功经历两步脱机策略后给予拔除气管插管的68例患者入选为研究对象。根据拔管失败定义(在24 h内需要重新插管)进一步分为拔管成功A组和拔管失败B组,各34例。测量两组患者自主呼吸试验(SBT)前及试验后1 h的各项参数。结果 SBT前A组氧合指数、动脉血氧分压略低于B组,但差异无统计学意义(P>0.05),SBT后1 h A组氧合指数、动脉血氧分压明显低于B组,差异有统计学意义(P<0.05)。A组SBT前后组内比较动脉血氧合指数下降3.3%,差异具有统计学意义(P<0.05)。结论动脉血氧合指数是困难脱机患者拔管失败的一个早期预测因子,1 h内下降3.3%以上可作为预测阈值。Objective To investigate the predictive value of arterial blood oxygenation index（PaO 2/FiO 2） changes for extubation failure in severe difficult weaning patients. Methods Among difficult weaning patients with over 48 h of mechanical ventilation, a total of 68 patients received two-step weaning strategy with extubation were selected as further study subjects. These patients were divided by the definition of failed extubation（necessary second intubation within 24 h） into successful extubation group A and extubation failure group B, and each group contained 34 cases. Indexes were measured before and in 1 h after spontaneous breathing trial（SBT）. Results Before SBT, the group A had lower oxygenation index and arterial partial pressure of oxygen than group B, while their difference was not statistical significance（P0.05）. In 1 h after SBT, the group A had lower oxygenation index and arterial partial pressure of oxygen than group B, and the difference had statistical significance（P〉0.05）. In group A, the arterial blood oxygenation decreased as 3.3% after SBT, compared with that before SBT. The difference had statistical signfiicance（P〈0.05）. Conclusion Arterial blood oxygenation index can be taken as a early predictive factor for extubation failure in difficult weaning patients, and its decrease larger than 3.3% in 1 h can be used as predictive threshold value.

关 键 词：动脉血氧合指数 机械通气 拔管 困难脱机 

分 类 号：R459.7[医药卫生—急诊医学]