不同自主呼吸试验模式对呼吸衰竭患者撤机拔管成功率及呼吸机相关性肺炎发生率的影响分析  

An analysis about the impact of different SBT modes on the success rate of weaning and extubation of ventilator and the incidence rate of ventilator-associated pneumonia on patients with respiratory failure

作　　者：姬长卫 聂文丽 刘园园 张芹[1] 王祝国 屈峰[1] 孙树印[1] 高淑红[1] JIChang-wei;NIE Wen-li;LIU Yuan-yuan(Intensive Care Unit, Jining No.1 People's Hospital, Jining 272000, China)

机构地区：[1]济宁市第一人民医院重症医学科

出　　处：《中国医学装备》2019年第6期84-86,共3页China Medical Equipment

摘　　要：目的:分析不同自主呼吸试验(SBT)模式对呼吸衰竭患者撤机拔管成功率和呼吸机相关肺炎发生率的影响程度,探讨导管补偿(TC)模式的临床应用价值。方法:回顾性分析326例呼吸衰竭患者资料,根据SBT模式的不同将其分为观察组和对照组,每组163例。观察组采用TC模式进行SBT,对照组采用压力支持通气(PSV)模式进行SBT。观察撤机拔管患者24h内临床症状,统计再次插管和呼吸机相关肺炎患者的比例,并观察分析两组撤机拔管治疗效果的差异性。结果:观察组中SBT成功138例,撤机拔管后48h内再次插管4例,呼吸机相关肺炎患者8例;对照组中SBT成功154例,撤机拔管后48h内再次插管19例,呼吸机相关肺炎患者20例,两组患者的撤机拔管成功率比较,差异有统计学意义(x^2=7.42,P<0.05);呼吸机相关肺炎发生率比较,差异有统计学意义(x^2=4.34,P<0.05)。结论:TC模式在预测撤机拔管成功率方面优于PSV模式,同时可以有效的控制呼吸机相关肺炎发生率,在提高临床治疗效果和呼吸机使用管理方面具有较高的应用价值。Objective: To analyze the impact degree of different spontaneous breathing trial (SBT) modes on the success rate of weaning and extubation of ventilator and the incidence rate of ventilator-associated pneumonia on patients with respiratory failure so as to investigate the clinical application value of tube compensation (TC) mode. Methods: The data of 326 patients with respiratory failure were retrospectively analyze, and these patients were divided into observation group and control group according to different SBT modes, 163 cases in each group. TC mode was used in observation group to implement SBT, and pressure supported ventilation (PSV) mode was used in control group to implement SBT. The clinical symptoms of patients within 24 hours post weaning and extubation were observed. And the proportion of re-intubation and the proportion of patients with ventilator-associated pneumonia were calculated as statistic method. Besides, the differences of curative effect of weaning and extubation between two groups were observed and analyzed. Results: In the observation group, 138 cases succeeded in SBT, and 4 cases had the intubation again within 48 hours post the weaning and extubation, and 8 cases occurred ventilator-associated pneumonia. The corresponding numbers of patients in the control group were 154, and 19 cases were intubation again within 48 h post weaning and extubation, and the number of patients with ventilator-associated pneumonia was 20 cases. The difference of the success rate of the weaning and extubation between the two groups was significant(x2=4.34, P<0.05). And the difference of incidence rate of ventilator-associated pneumonia was significant(x2=4.34, P<0.05). Conclusion: TC mode is better in predicting the successful rate of weaning and extubation than that of PSV mode. At the same time, it can effectively control the incidence rate of ventilator-associated pneumonia, and it has higher application value in improving the clinical therapeutic effect and the use management of ventilator.

关 键 词：自主呼吸试验 导管补偿模式 撤机拔管 呼吸机相关性肺炎 无创正压机械通气 

分 类 号：R563[医药卫生—呼吸系统]