机械通气脱机重要环节——准确评估呼吸肌力  

Important step of weaning from mechanical ventilation:accurate assessment of respiratory muscle strength

作　　者：秦英智 高心晶 Qin Yingzhi;Gao Xinjing(Department of Critical Care Medicine,Tianjin Third Central Hospital,Tianjin 300170,China)

机构地区：[1]天津第三中心医院重症医学科,天津300170

出　　处：《中华危重病急救医学》2024年第4期337-339,共3页Chinese Critical Care Medicine

摘　　要：机械通气(MV)是抢救呼吸衰竭患者的有力手段。由于呼吸衰竭患者病因及基础呼吸功能各异,常出现脱机失败。MV时间延长常伴各种并发症。了解呼吸衰竭的病理生理学变化、加强呼吸力学监测有助于优化MV参数设置、减轻呼吸机相关性肺损伤及尽早脱机。脱机成败取决于多种因素,最主要的因素为呼吸肌力、呼吸负荷和呼吸驱动强度。自主呼吸试验(SBT)是脱机过程的重要一环,实施SBT的主要目的是筛选脱机患者和时机、寻找不能通过SBT的可逆原因。由于SBT评估脱机预后的准确率约为85%,对于脱机困难患者,仅凭临床评估是不够的。规范测定脱机指标有利于准确评估脱机困难患者呼吸肌力,提高脱机成功率。Mechanical ventilation(MV)is a powerful mean to rescue patients with respiratory failure.In view of the different etiology and basic respiratory function of patients with respiratory failure,weaning failure often occurs.Prolonged MV time is often accompanied by many complications.Thus,deeply understanding the pathophysiological changes of respiratory failure and strengthen monitoring of respiratory mechanics are helpful to optimize MV parameter settings,reduce ventilator-induced lung injury and wean from MV as early as possible.A successful weaning from MV depends on many factors,the most important factors are respiratory muscle strength,respiratory load and respiratory drive.Spontaneous breathing trial(SBT)is an important part of weaning process.The main purpose of implementing SBT is to screen patients and opportunities to weaning from MV,and find reversible reasons for not passing SBT.Because the accuracy of SBT in assessing weaning prognosis is about 85%,it is not adequate for difficult weaning patients.Standardized measurement of weaning indicators for patients with difficulty weaning is conducive to accurate assessment of respiratory muscle strength and improve the success rate of weaning from MV.

关 键 词：机械通气 脱机 自主呼吸试验 浅快呼吸指数 最大吸气压 综合脱机指数 

分 类 号：R459.7[医药卫生—急诊医学]