ICU脑出血患者开颅血肿清除术后机械通气撤机时间选择的研究  

Selection Research of Mechanical Ventilation Weaning Time of Intracerebral Hemorrhage Patients after Craniotomy and Hematoma Removal in ICU

作　　者：戴纪明[1] DAI Jiming(ICU Department,Funing County People's Hospital,Funing,Jiangsu 224400)

机构地区：[1]阜宁县人民医院重症医学科,江苏阜宁224400

出　　处：《智慧健康》2023年第5期71-75,97,共6页Smart Healthcare

摘　　要：目的 探讨ICU脑出血患者开颅血肿清除术后机械通气不同撤机时机对患者预后的影响。方法 选取2021年1月-2022年2月阜宁县人民医院重症医学科收治的70例脑出血患者,全部患者均行开颅血肿清除手术治疗,手术操作由同一神经外科团队完成,术后持续机械通气,采用随机数字表法分为两组,予以不同的呼吸机撤离时间方案。A组35例,早期撤离呼吸机,即手术完成后在患者恢复自主呼吸、生命体征平稳时立即撤机;B组35例,在手术完成后脑组织度过水肿高峰期时撤机。统计两组机械通气时间与一次撤机成功率,测定两组首次撤机后呼吸系统功能指标RR、SpO_(2)、PaO_(2)与PaCO_(2)。治疗前及出院时,以NIHSS量表评价两组神经功能,ADL量表评价两组患者日常生活能力,统计两组机械通气相关并发症发生率。结果 A组机械通气时间短于B组,差异有统计学意义(P<0.05)。两组一次撤机成功率、首次撤机后24h的呼吸系统功能指标RR、SpO_(2)、PaO_(2)、PaCO_(2)与出院时的NIHSS与ADL评分、机械通气相关并发症发生率均无统计学差异(P>0.05)。结论ICU脑出血患者开颅血肿清除术后早期撤离呼吸机的一次成功率与脑水肿高峰期后撤离呼吸机相当,以两种方案撤机后的患者呼吸功能恢复、神经系统恢复、预后情况及安全性也基本相同,临床可根据患者实际情况具体选择撤机时间,以帮助患者更好康复。Objective To explore effect of different mechanical ventilation withdrawal timing on prognosis of intracerebral hemorrhage patients after craniotomy and hematoma removal in ICU.Methods The paper chose 70 patients with cerebral hemorrhage admitted to ICU Department of Funing County People's Hospital from January 2021 to February 2022,with craniotomy and hematoma removal surgery by same neurosurgical team.After surgery,mechanical ventilation was continued.Patients were divided into two groups,treated with different ventilator evacuation time schemes.35 cases in group A were evacuated from ventilator at an early stage,that is,immediately after surgery when patient regained autonomous breathing with stable vital signs,35 cases in group B were weaned when brain tissue passed peak of edema after surgery.Duration of mechanical ventilation and success rate of first weaning in two groups was counted,respiratory system functional indicators RR,SpO_(2),PaO_(2),and PaCO_(2) was measured after the first weaning of two groups.Before treatment and at discharge,neurological function between two groups was evaluated with NIHSS scale,and daily living ability between two groups was evaluated with ADL scale.Incidence of mechanical ventilation related complications between two groups was counted.Results Mechanical ventilation time in Group A was shorter than Group B,with statistically significant difference(P<0.05).There was no significant difference between two groups in success rate of first weaning,respiratory function indicators RR,SpO_(2),PaO_(2),PaCO_(2),and NIHSS and ADL scores at discharge,as well as incidence of mechanical ventilation related complications 24 hours after the first weaning(P>0.05).Conclusion Right first time success rate of early evacuation of ventilators of intracerebral hemorrhage patients after craniotomy and hematoma removal in ICU is similar to that after peak period of brain edema.Recovery of respiratory function,neurological system,prognosis,and safety of patients after evacuation with both schemes is

关 键 词：ICU 脑出血 开颅血肿切除术 机械通气 撤机时机 

分 类 号：R651.12[医药卫生—外科学]