不同SBT策略对机械通气患者肺通气量的影响  

Influence of Different Ventilation Strategies During Spontaneous Breathing Trials on Lung Aeration Among Patients Receiving Mechanical Ventilation

作　　者：李美菊 李文卓 柳金玲 杨莉[1] 朱明贤 夏婧[1] LI Meiju;LI Wenzhuo;LIU Jinling;YANG Li;ZHU Mingxian;XIA Jing(Dept.of Emergency Medicine,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032,China)

机构地区：[1]昆明医科大学第一附属医院急救医学部,云南昆明650032

出　　处：《昆明医科大学学报》2022年第7期110-115,共6页Journal of Kunming Medical University

基　　金：云南省教育厅科学研究基金资助项目(2021J0236);北京协和医学基金-睿E(睿意)急诊医学科研专项基金资助项目(R2021014)。

摘　　要：目的观察对比不同SBT策略对机械通气患者肺通气影响。方法纳入2020年6月至2021年1月收住某医科大学附属医院EICU的符合纳入、排除标准,进行首次SBT的机械通气患者69例。随机分入T管组、PSV组及ATC组后进行30 min的SBT。SBT成功后24 h内拔除气管插管。所有患者SBT开始前(T0)、结束时(T1)及拔管后30 min(T2)用超声观察患者肺通气状态。结果3组患者首次SBT通过率差异无统计学意义(P>0.05),成功拔管的患者中:T1时3组患者LUS评分差异无统计学意义(P>0.05),从T1到T2,T管组患者LUS变化未见明显统计学差异(P>0.05),PSV组及ATC组患者LUS增加(P<0.05)。结论有压力支持的SBT策略有利于患者通过SBT,同时在SBT过程中保证肺部通气量;然而,T管法SBT似乎更能预测患者拔管后的肺通气量变化。Objective To evaluate the difference of Pressure Support vs T-Piece vs Automatic Tube Compensation Ventilation Strategies during Spontaneous Breathing Trials on lung aeration.Methods Sixty-nine cases of mechanically ventilated patients who were prepared to undergo the first spontaneous breathing trial(SBT)in EICU of an affiliated Hospital of Medical University from June 2020 to January 2021 were included.They were randomly divided into T-Piece group,Pressure Support Ventilation(PSV)group and Automatic Tube Compensation(ATC)group for 30 minutes of SBT.After successful SBT,the tracheal intubation was removed within 24 hours.We observed the patients’Lung Ultrasound Scores(LUS)with ultrasound before the beginning of SBT(T0),at the end of SBT(T1)and 30 minutes after extubation(T2)in all patients.Results At the end of SBT,the LUS of the three groups were not significantly different(P>0.05).The LUS of patients in T-Piece,there was no significant difference in the changes from T1 to T2(P>0.05).The LUS of patients in the PSV group and ATC group increased from T1 to T2(P<0.05).Conclusion SBT strategy with pressure support is helpful for patients to pass SBT and ensure lung ventilation during SBT,however,T-tube SBT seems to be a better predictor of lung ventilation after extubation.

关 键 词：自主呼吸试验 脱机 肺脏超声 自动导管补偿 压力支持通气 

分 类 号：R563.9[医药卫生—呼吸系统]