预防性应用无创机械通气降低咳嗽能力差患者拔管失败的有效性研究  

Efficacy of preventive use of noninvasive ventilation in planned extubated patients with weak cough

作　　者：段敏[1] 白林富 段均[1] 

机构地区：[1]重庆医科大学附属第一医院呼吸内科,重庆400016

出　　处：《重庆医科大学学报》2017年第1期50-53,共4页Journal of Chongqing Medical University

摘　　要：目的:探讨咳嗽能力差的患者拔管后预防性应用无创机械通气降低拔管失败的有效性。方法:选择2011至2015年入住我科监护室通过自主呼吸撤机试验准备拔管且咳嗽能力差的106例患者为研究对象。咳嗽能力差定义为患者拔管时半定量咳嗽能力评估小于等于2级。拔管后57例患者预防性使用无创机械通气以减少拔管后呼吸功能衰竭的发生(试验组),另有49例患者仅接受常规的鼻导管吸氧(对照组)。主要观察结局指标为拔管后72 h再插管率。结果:预防性应用无创通气显著降低患者拔管后72 h再插管率(12%vs.39%,P=0.003)。多变量逻辑回归分析发现,预防性应用无创通气是拔管后72 h再插管的保护因子(风险比OR=0.22,95%CI=0.08~0.59,P=0.002)。在存活的患者中,预防性应用无创通气显著缩短了患者住重症监护室时间(13 d vs.21 d,P=0.04)。结论:咳嗽能力差的患者通过自主呼吸撤机试验拔管后,预防性应用无创通气可以降低患者的再插管率。Objective：To explore the efficacy of preventive use of noninvasive ventilation in weak cough patients who was planned for extubation. Methods：This study was performed in a intensive care unit from 2011 to 2015,and one hundred and six patients who successfully completed a spontaneous breathing trial were enrolled. Weak cough was defined that the semiquantitative cough strength scale was rated less than 2 assessed at extubation. Finally,59 patients received preventive use of noninvasive ventilation immediately after extubation（intervention group）and 49 patients received conventional oxygenation by nasal cannula（control group）. The primary outcome was re-intubation rate within 72 hours after extubation. Results：Preventive use of noninvasive ventilation reduced re-intubation at 72 hours after extubation compared with control group（12% vs. 39%,P=0.003）. Further,multivariable logistic regression analysis showed that preventive use of noninvasive ventilation was a protective factor for re-intubation at 72 hours after extubation（odds ratio=0.22,95% confidence interval=0.08 to 0.59,P=0.002）. In survivors,preventive use of noninvasive ventilation also reduced intensive care unit stay（13 days vs. 21 days,P=0.04）. Conclusion：Preventive use of noninvasive ventilation can reduce re-intubation in weak cough patients who successfully passed a spontaneous breathing trial.

关 键 词：气管插管 自主呼吸撤机试验 无创机械通气 咳嗽能力 

分 类 号：R459.7[医药卫生—急诊医学]