压力支持模式在颅脑创伤合并肋骨骨折患者的撤机效果  

The weaning effect of pressure support mode in patients with craniocerebral trauma complicated with rib fracture

作　　者：余志阳[1] 张忠华 陈春龙 嵇晴[1] 朱四海[1] 张利东[1] 刘杨[1] YU Zhi-yang;ZHANG Zhong-hua;CHEN Chun-long;JI Qing;ZHU Si-hai;ZHANG Li-dong;LIU Yang(Department of Anesthesiology,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]东部战区总医院(原南京军区南京总医院)麻醉科,南京210002

出　　处：《医学研究生学报》2021年第6期600-603,共4页Journal of Medical Postgraduates

基　　金：原南京军区面上课题(YYZD2014001)。

摘　　要：目的目前有关重症创伤患者呼吸机撤机的临床研究较少。文中旨在观察持续气道正压(CPAP)复合压力支持通气(PSV)撤机模式在重症颅脑创伤合并多发肋骨骨折患者的呼吸机撤机效果。方法回顾性分析2017年1月至2020年12月东部战区总医院麻醉科重症监护病房(AICU)30例重症颅脑创伤合并肋骨骨折患者的临床资料。根据撤机模式分为直接撤机组(患者达到AICU制定的撤机标准后,直接撤除呼吸机辅助呼吸,n=16)及辅助撤机组(患者达到辅助呼吸标准后,呼吸机通气模式转换为PSV+CPAP,当达到撤机标准后撤离呼吸机,n=14)。统计分析比较2组48 h撤机成功率、呼吸机撤机时间、机械通气时间、AICU治疗时间、镇静药物的用量。结果2组患者均成功实现呼吸机撤离且无死亡。辅助撤机组48 h撤机成功率(57.1%)明显高于直接撤机组(18.8%),撤机时间、AICU住院时间、呼吸机治疗时间明显低于直接撤机组(P<0.05),镇静药(咪达唑仑和右美托咪定)使用量明显低于直接撤机组(P<0.01)。结论CPAP复合PSV撤机模式优于直接撤机模式,是重症颅脑创伤合并多发肋骨骨折患者优选的撤机模式。Objective At present,there are few clinical studies on ventilator weaning in patients with severe trauma.This study aims to observe the ventilator weaning effect of continuous positive airway pressure(CPAP)combined with pressure support ventilation(PSV)in patients with severe craniocerebral trauma complicated with multiple rib fractures.Methods The clinical data of 30 patients with severe craniocerebral trauma complicated with rib fracture in the Anesthesiology and Intensive Care Unit(AICU)of the General Hospital of the Eastern Theater Command from January 2017 to December 2020 were retrospectively analyzed.According to the weaning mode,it can be divided into direct weaning group(after the patient meets the standard set by AICU,the ventilator assisted breathing is directly removed,n=16)and auxiliary weaning group(after the patient meets the standard,the ventilation mode is converted to PSV+CPAP,and the ventilator is weaned after the standard is reached,n=14).The success rate of 48h weaning,the weaning time of ventilator,the duration of mechanical ventilation,the duration of AICU treatment and the dosage of sedatives were statistically analyzed and compared between the two groups.Results Patients in both groups were successfully weaned from the ventilator without death.The success rate of 48h weaning in the auxiliary weaning group(57.1%)was significantly higher than that in the direct weaning group(18.8%),the weaning time,AICU hospitalization time and ventilator treatment time were significantly lower than those in the direct weaning group(P<0.05),and the dosage of sedatives(midazolam and dexmedetomidine)was significantly lower than that in the direct weaning group(P<0.01).Conclusion The weaning mode of CPAP+PSV is superior to the direct weaning mode,and is preferred for patients with severe craniocerebral trauma complicated with multiple rib fractures.

关 键 词：颅脑创伤 肋骨骨折 机械通气撤机 

分 类 号：R742[医药卫生—神经病学与精神病学]