呼吸指数、氧合指数和PaCO_(2)动态监测在呼吸衰竭患者有创机械通气脱机后拔管中的价值探讨  

The value of dynamic monitoring of respiratory index,oxygenation index and PaCO_(2)in extubation from invasive mechanical ventilation in patients with respiratory failure

作　　者：石代辉[1] 周达坤 黄小倩 何立术 洪允钦 SHI Dai-hui;ZHOU Da-kun;HUANGXiao-qian(ICU,the Second People's Hospital of Qinzhou,Guangxi Zhuang Autonomous Region,Qinzhou 535000,China)

机构地区：[1]广西壮族自治区钦州市第二人民医院ICU一区,535000

出　　处：《中国实用医药》2025年第2期6-11,共6页China Practical Medicine

基　　金：钦州市科学研究与技术开发计划项目(项目编号:20213717)。

摘　　要：目的探讨呼吸衰竭有创机械通气患者动态监测呼吸指数(RI)、氧合指数(OI)、动脉血二氧化碳分压(PaCO_(2))对脱机后拔管的评估价值。方法选择150例行有创机械通气治疗的呼吸衰竭患者,根据拔管评估情况分为观察组和对照组,其中成功拔管的75例患者为观察组,未成功拔管的75例患者为对照组。检测并比较两组患者脱机前、脱机后30 min~1 h、脱机后1~2 h的RI、OI、PaCO_(2),脱机后30 min~1 h、1~2 h的RI增加率、OI降低率及RI增加≥50%、RI增加≥100%、OI降低≥50%以及PaCO_(2)降低≥50%情况。结果两组患者脱机前的RI、OI、PaCO_(2)比较,差异均无统计学意义(P>0.05)。两组患者脱机后RI均升高;观察组脱机后30 min~1 h、1~2 h的RI(1.66±0.08)、(1.65±0.09)均明显低于对照组的(2.42±0.35)、(3.04±0.26),差异有统计学意义(P<0.05)。两组患者脱机后OI均降低;观察组脱机后30 min~1 h、1~2 h的OI(242.06±9.33)、(247.23±10.81)mm Hg(1 mm Hg=0.133 kPa)均明显高于对照组的(188.66±9.30)、(146.87±6.65)mm Hg,差异有统计学意义(P<0.05)。观察组脱机后PaCO_(2)降低,对照组脱机后PaCO_(2)先升高而后下降;观察组脱机后30 min~1 h、1~2 h的PaCO_(2)(37.29±0.88)、(37.17±1.03)mm Hg均低于对照组的(41.18±1.49)、(39.17±1.55)mm Hg,差异有统计学意义(P<0.05)。与观察组脱机后30 min~1 h、1~2 h相比,对照组RI增加率、OI降低率更高,差异有统计学意义(P<0.05),观察组指标的变化相对更低更平稳。两组患者脱机后30 min~1 h、1~2 h RI增加≥50%的比例比较,差异无统计学意义(P>0.05);观察组脱机后1~2 h的RI增加≥100%的比例29.33%明显低于对照组的54.67%,差异有统计学意义(P<0.05)。观察组脱机后30 min~1 h、1~2 h OI降低≥50%的比例4.00%、9.33%均明显低于对照组的21.33%、44.00%,差异有统计学意义(P<0.05)。两组患者脱机后30 min~1 h、1~2 h PaCO_(2)降低≥50%的比例比较,差异无统计学意义(P>0.05)。结论动To explore the evaluation value of dynamic monitoring of respiratory index(RI),oxygenation index(OI)and arterial partial pressure of carbon dioxide(PaCO_(2))in extubation after extubation from invasive mechanical ventilation in patients with respiratory failure.Methods 150 patients with respiratory failure treated with invasive mechanical ventilation were selected and divided into an observation group and a control group according to the evaluation of extubation.75 patients with successful extubation were included in the observation group and 75 patients with unsuccessful extubation were included in the control group.The RI,OI and PaCO_(2)between were detected and compared the two groups before weaning,at 30 min-1 h after weaning and at 1-2 h after weaning;the RI increase rate,OI decrease rate,RI increase by≥50%,RI increase by≥100%,OI decrease by≥50%,and PaCO_(2)decrease by≥50% were compared between the two groups at 30 min-1 h and 1-2 h after weaning.Results There was no significant difference in RI,OI and PaCO_(2)between the two groups before weaning(P>0.05).RI increased in both groups after weaning.RI in the observation group were(1.66±0.08)and(1.65±0.09)at 30 min-1 h and 1-2 h after weaning,which were significantly lower than(2.42±0.35)and(3.04±0.26)in the control group,and the difference was statistically significant(P<0.05).OI decreased in both groups after weaning.OI in the observation group were(242.06±9.33)and(247.23±10.81)mm Hg(1 mm Hg=0.133 kPa)at 30 min-1 h and 1-2 h after weaning,which were significantly higher than(188.66±9.30)and(146.87±6.65)mm Hg in the control group.The difference was statistically significant(P<0.05).PaCO_(2)in the observation group decreased after weaning,while PaCO_(2)in the control group increased first and then decreased after weaning.PaCO_(2)in the observation group were(37.29±0.88)and(37.17±1.03)mm Hg at 30 min-1 h and 1-2 h after weaning,which were lower than(41.18±1.49)and(39.17±1.55)mm Hg in the control group,and the difference was statistically sign

关 键 词：呼吸衰竭 有创机械通气 拔管评估 呼吸指数 氧合指数 动脉血二氧化碳分压 

分 类 号：R563.8[医药卫生—呼吸系统]