中心静脉氧饱和度监测降低困难撤机患者的再插管率  

Center venous oxygen saturation monitoring guide extubation in difficult-to-wean patients

作　　者：陈培服[1,2] 唐时元[1] 曹钰[1] 

机构地区：[1]四川大学华西医院急诊科,四川成都610041 [2]宁波市第二医院ICU,浙江宁波315010

出　　处：《西部医学》2017年第3期322-325,334,共5页Medical Journal of West China

基　　金：国家卫计委卫生行业科研专项项目(201302003)

摘　　要：目的探讨在传统自主呼吸试验(SBT)指导撤机策略的基础上,中心静脉血氧饱和度(ΔScvO_2%)下降程度能否预估困难撤机患者的拔管成功率及ΔScvO_2监测指导困难撤机患者拔管的机理。方法以2015年10月16日~2016年7月27日宁波市第二医院ICU机械通气患者中的困难撤机再次SBT成功患者25例为研究对象,根据在SBT过程中ΔScvO_2%是否>4.5%,将患者分成高ΔScvO_2%组(ΔScvO_2%>4.5%)和低ΔScvO_2%组(ΔScvO_2%≤4.5%),记录并比较两组患者的性别、年龄、身高、体重,急性生理和慢性健康评分(APACHEⅡ),血红蛋白浓度,主要疾病诊断等一般资料,以及两组患者SBT前后的呼吸(RR)、心率(HR)、血压(HB)、中心静脉压(CVP)及血气指标(PH、PaCO_2、PaO_2、SaO_2、Lac、PcvCO_2、PcvO_2、ScvO_2),心排量(CO)、心脏指数(CI)、左室射血分数(EF)、CO增加比例(ΔCO%)、氧输送增加值(ΔDO_2)、氧输送增加比例(ΔDO_2%)和再插管率。结果两组患者SBT前后的呼吸、心率、血压、CVP及血气指标(PH、PaCO_2、PaO_2、SaO_2、Lac、PcvCO_2、PcvO_2)方面差异均无统计学意义(P>0.05)。而高ΔScvO_2%组的再插管率(2/3例)显著高于低ΔScvO_2%组(1/22例,P<0.05)。结论对于困难撤机患者,在传统SBT的基础上增加ScvO_2≤4.5%指标可降低拔管后的再插管率。其机理可能是ΔScvO_2%相比于传统SBT指标更能反映心肺的代偿功能和氧代射情况。Objective To assess whether central venous oxygen saturation （ScvOz） monitoring during spontaneous breathing trial （SBT） could reduce the re-intubation rate in difficult-to-wean patients. Methods All the difficult-to-wean patients monitored in the intensive care unit from October 16, 2015 to Julyl7, 2016 were taken for the study group. Retrospective analysis of the re-intubation rate of difficult-to-wean patients with different levels of center venous oxygen saturation decreased （△ScvO2 %） during SBT. The gender, age, height, weight, Acute Physiology and Chronic Health （△PACHE Ⅱ ） score, and hemoglobin concentration were cllected. All the patients were divided into high △ScvO2 % group （△ScvO2%〉4.5%） and low △ScvO2 O% group （△ScvO2%≤4.5%）, and then the re-intubation rate were compared between the two groups. The respiratory rate, heart rate, blood pressure, central venous pressure （CVP） and blood gas parameters （pH, PaCO2 , PaO2, SaO2, LAC, PcvCO2 , PcvO2 ,ScvO2）, cardiac output （CO）, and cardiac index （CI）, ejection fraction of left ventricular （EF） before and after SBT were compared. The increase ratio of CO （△CO%）, oxygen delivery （△DO2%） and the increase of oxygen delivery value （△DO2） was calculated and compared. Results All the 25 patients were tracheal extubated after a successful SBT. The re-intubation rate in low △ScvO2 % group （1/22） is lower than the high △ScvO2% group（2/3）, P〈0.05. Conclusion During SBT in difficult-to-wean patients, patients with ScvO2 reduction≤4.5% may have low rate of re-intubation.

关 键 词：中心静脉氧饱和度 机械通气 困难撤机 拔管 再插管 

分 类 号：R459.7[医药卫生—急诊医学]