低水平辅助通气与T管法对机械通气患者撤机时呼吸力学的影响比较  

Comparison of the effects between low-level assisted ventilation and T-piece method on respiratory mechanics during weaning of mechanically ventilated patients

作　　者：王诗雅 蒋振杰 张宝珠 陆广生 王志敏[3] 林志敏[1] 陈强[1] 杨淳[1] 孙庆文[1] 阮红莲 徐远达[1] Wang Shiya;Jiang Zhenjie;Zhang Baozhu;Lu Guangsheng;Wang Zhimin;Lin Zhimin;Chen Qiang;Yang Chun;Sun Qingwen;Ruan Honglian;Xu Yuanda(Department of Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory Health,Guangzhou 510120,Guangdong,China;Department of Critical Care Medicine,First People's Hospital of Zhaoqing,Zhaoqing 526000,Guangdong,China;Department of Critical Care Medicine,the Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou 510700,Guangdong,China;Guangzhou Medical University,Public Health Teaching and Research Office,Guangzhou 510030,Guangdong,China)

机构地区：[1]广州医科大学附属第一医院重症医学科,广州呼吸健康研究院,广东广州510120 [2]肇庆市第一人民医院重症医学科,广东肇庆526000 [3]广州医科大学附属第五医院重症医学科,广东广州510700 [4]广州医科大学公共卫生教研室,广东广州510030

出　　处：《中华危重病急救医学》2021年第6期697-701,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81490534);国家临床重点专科建设项目(2011-872);广州呼吸健康研究院/广州医科大学附属第一医院国家临床研究中心临床自主探索项目(2019GIRHZ10)。

摘　　要：目的有创机械通气患者在拔管前3 d内进行自主呼吸试验(SBT)时应用低水平辅助通气与T管法对呼吸力学差异的比较。方法采用回顾性观察性研究方法。纳入2018年12月至2020年6月广州医科大学附属第一医院重症医学科收治的有创机械通气时间超过72 h、病情稳定且进入撤机阶段的25例困难撤机或延迟撤机患者作为研究对象,共收集到119例次呼吸力学指标,根据数据收集时使用的通气模式分为低水平辅助通气组和T管组。比较两组不同通气模式相关呼吸力学指标如食道压(Pes)、胃内压(Pga)、跨膈压(Pdi)、最大跨膈压(Pdimax)、Pdi/Pdimax比值、食道压-时间乘积(PTPes)、胃内压-时间乘积(PTPga)、跨膈压-时间乘积(PTPdi)、膈肌肌电(EMGdi)、膈肌肌电最大值(EMGdimax)、PTPdi/PTPes比值、Pes/Pdi比值、吸气时间(Ti)、呼气时间(Te)、呼吸周期(Ttot)的差异。结果与T管组比较,低水平辅助通气组有更高的Pes、PTPes、PTPdi/PTPes比值、Pes/Pdi比值和Te〔Pes(cmH_(2)O,1 cmH_(2)O=0.098 kPa):2.84(-1.80,5.83)比-0.94(-8.50,2.06),PTPes(cmH_(2)O·s·min^(-1)):1.87(-2.50,5.93)比-0.95(-971,2.56),PTPdi/PTPes比值:0.07(-1.74,1.65)比-1.82(-4.15,-1.25),Pes/Pdi比值:0.17(-0.43,0.64)比-0.47(-0.65,-0.11),Te(s):1.65(1.36,2.18)比1.33(1.05,1.75),均P<0.05〕;而T管组与低水平辅助通气组Pga、Pdi、Pdimax、Pdi/Pdimax比值、PTPga、PTPdi、EMGdi、EMGdimax、Ti、Ttot比较差异均无统计学意义〔Pga(cmH_(2)O):6.96(3.54,7.60)比7.74(4.37,11.30),Pdi(cmH_(2)O):9.24(4.58,17.31)比6.18(2.98,11.96),Pdimax(cmH_(2)O):47.20(20.60,52.30)比29.95(21.50,47.20),Pdi/Pdimax比值:0.25(0.01,0.34)比0.25(0.12,0.41),PTPga(cmH_(2)O·s·min^(-1)):7.20(2.54,9.97)比7.97(5.74,13.07),PTPdi(cmH_(2)O·s·min^(-1)):12.15(2.95,19.86)比6.87(2.50,12.63),EMGdi(μV):0.05(0.03,0.07)比0.04(0.02,0.06),EMGdimax(μV):0.07(0.05,0.09)比0.07(0.04,0.09),Ti(s):1.20(0.95,1.33)比1.07(0.95,1.33),Ttot(s):2.59(2.22,3.09)比2.77(2.35,3.24),均P>0.05〕。�Objective To compare the difference of low-level assisted ventilation and T-piece method on respiratory mechanics of patients with invasive mechanical ventilation during spontaneous breathing trial(SBT)within 3 days before extubation.Methods A retrospective observational study was conducted.Twenty-five patients with difficulty in weaning or delayed weaning from invasive mechanical ventilation who were admitted to department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from December 2018 to June 2020,and were in stable condition and entered the weaning stage after more than 72 hours of invasive mechanical ventilation were studied.A total of 119 cases of respiratory mechanical indexes were collected,which were divided into the low-level assisted ventilation group and the T-piece group according to the ventilator method and parameters used during the data collection.The different ventilation modes related respiratory mechanics indexes such as the esophageal pressure(Pes),the gastric pressure(Pga),the transdiaphragmatic pressure(Pdi),the maximum Pdi(Pdimax),Pdi/Pdimax ratio,the esophageal pressure-time product(PTPes),the gastric pressure-time product(PTPga),the transdiaphragmatic pressure-time product(PTPdi),the diaphragmatic electromyography(EMGdi),the maximum diaphragmatic electromyography(EMGdimax),PTPdi/PTPes ratio,Pes/Pdi ratio,the inspiratory time(Ti),the expiratory time(Te)and the total time respiratory cycle(Ttot)at the end of monitoring were recorded and compared between the two groups.Results Compared with the T-piece group,Pes,PTPes,PTPdi/PTPes ratio,Pes/Pdi ratio and Te were higher in low-level assisted ventilation group[Pes(cmH_(2)O,1 cmH_(2)O=0.098 kPa):2.84(-1.80,5.83)vs.-0.94(-8.50,2.06),PTPes(cmH_(2)O·s·min^(-1)):1.87(-2.50,5.93)vs.-0.95(-9.71,2.56),PTPdi/PTPes ratio:0.07(-1.74,1.65)vs.-1.82(-4.15,-1.25),Pes/Pdi ratio:0.17(-0.43,0.64)vs.-0.47(-0.65,-0.11),Te(s):1.65(1.36,2.18)vs.1.33(1.05,1.75),all P<0.05],there were no significant differences in Pga,Pd

关 键 词：有创机械通气 低水平辅助通气 T管 呼吸力学 

分 类 号：R459.7[医药卫生—急诊医学]