重症超声评估流程在机械通气撤机拔管中的应用价值  

Application value of critical ultrasound evaluation process in weaning and extubation of mechanical ventilation

作　　者：蒋勇[1] 李华丽[1] 邓光进 曾佑强 朱亚容 JIANG Yong;LI Huali;DENG Guangjin;ZENG Youqiang;ZHU Yarong(Intensive Care Unit,People′s Hospital of Yingde City,Guangdong Province,Yingde513000,China)

机构地区：[1]广东省英德市人民医院重症医学科,广东英德513000

出　　处：《中国当代医药》2023年第5期57-59,共3页China Modern Medicine

摘　　要：目的探讨重症超声评估流程在机械通气撤机拔管中的应用价值。方法选取2021年1至10月于英德市人民医院重症医学科(ICU)采用机械通气的208例患者作为研究对象,按时间段将其分为对照组102例与研究组106例,其中2021年1至5月患者作为对照组,2021年6至10月患者作为研究组。对照组经治疗在撤离呼吸机拔除气管插管前,根据主管医生对患者体格检查、影像学及实验室检查结果评估,决定是否拔管。研究组在对照组的基础上,采用自行设计程序化重症超声评估流程,对机械通气患者心功能、肺部影像状况、膈肌功能及吞咽功能量化评估,决定是否拔管。比较两组患者机械通气时间、ICU平均住院时间、ICU气管插管拔管后48 h内再插管率、ICU转出后48 h内重返率。结果研究组患者的机械通气时间和ICU平均住院时间均短于对照组,差异有统计学意义(P<0.05)。研究组患者的ICU气管插管拔管后48 h内再插管率和ICU转出后48 h内重返率均低于对照组,差异有统计学意义(P<0.05)。结论自行设计程序化重症超声评估流程决定是否拔出气管插管,能缩短患者机械通气时间和ICU平均住院时间,降低ICU气管插管拔管后48 h内再插管率和ICU转出后48 h内重返率。Objective To explore the application value of critical ultrasound evaluation process in weaning and extubation of mechanical ventilation.Methods Two hundred and eight patients received mechanical ventilation in Intensive Care Unit(ICU)of People′s Hospital of Yingde City from January to October 2021 were selected as the study subjects,and they were divided into the control group(102 cases)and the study group(106 cases)according to the time period.The patients from January to May 2021 would be the control group,and the patients from June to October 2021 would be the study group.After treatment,the control group decided whether to remove the tracheal intubation before evacuating the ventilator according to the evaluation of the patients′physical examination,imaging and laboratory examination by the doctor in charge.On the basis of the control group,the study group adopted the self-designed procedure of critical ultrasound evaluation to quantitatively evaluate the cardiac function,pulmonary imaging status,diaphragm function and swallowing function of patients with mechanical ventilation,and decided whether to remove the catheter.The time of mechanical ventilation,the average hospitalization time in ICU,the re-intubation rate within 48 hours after extubation of endotracheal tube in ICU and the return rate within 48 hours after ICU transfer out were compared between the two groups.Results The time of mechanical ventilation,the average hospitalization time in ICU in the study group were shorter than those in the control group,and the differences were statistically significant(P<0.05).The re-intubation rate within 48 hours after extubation of endotracheal tube in ICU and the return rate within 48 hours after ICU transfer out in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Self designed programmed severe ultrasound evaluation process to determine whether to pull out the endotracheal tube can shorten the time of mechanical ventilation a

关 键 词：超声 机械通气 再插管率 重返率 气管插管 

分 类 号：R459.7[医药卫生—急诊医学]