呼吸机撤机困难策略的比较研究(1)
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[摘要] 目的 研究呼吸机难撤机患者不同撤机策略的效能及其临床意义。 方法 选择本院重症监护室呼吸衰竭后呼吸机撤机困难患者75例，随机分为5组，分别采用不同的撤机方法，压力支持(PSV)撤机组(A组)15例，压力支持联合同步间歇指令通气(PSV+SIMV)组(B组)15例，T管通气撤机组15例(C组)，持续气通正压通气(CPAP)撤机组15例(D组)，同步间歇指令通气(SIMV)撤机组(E组)15例，观察比较不同撤机策略的效能。 结果 各组撒机前的基线资料比较，差异无统计学意义(P > 0.05)。PSV撤机设置初始压力水平(Baseline PS)，使患者RR < 25 bpm，Vt为5～8 mL/kg临床效果较好。压力支持撤机、压力支持联合同步间歇指令通气撤机效能明显高于T管撤机、CPAP撤机、SIMV撤机，差异有统计学意义(P < 0.05)。 结论 本文显示全面评估患者情况、把握撤机时机，是策略性撤机的重要内容；且PSV程序撤机较其他方法有一定优越性。
[关键词] 呼吸机；撤机困难；策略；压力支持撤机；同步间歇指令通气
[中图分类号] R45 [文献标识码] A [文章编号] 1674-4721(2012)04(a)-0018-03
Comparative study Breathing machine ventilator weaning difficult strategy
LIU Sun AI Yuhang1 QIN Shuangquan2
1. Severe Medical Department, Xiangya Hospital Central-South University in Hunan Province, Changsha 410008, China; 2.Emergency Department of Changde City First People's Hospital in Hunan Province, Changde 415000, China
[Abstract] Objective To research the ventilator patients removed from machine, and investigate the efficiency of different strategies and their clinical significance. Methods Seventy five cases of respiratory failure patients weaning difficult after breathing machines ventilator were divided into PSV group (group A) with 15 cases, SIMV+PSV group( group B) with 15 cases, T tube ventilation group(group C) with 15 cases, CPAP group(group C) with 15 cases, SIMV group with 15 cases, and study the efficacy of different ventilator weaning strategy. Results The baseline data of each group before machine had no statistically significant difference (P > 0.05). PSV ventilator weaning setting initial pressure level( Baseline PS) to patients' RR < 25 bpm, Vt 5-8 mL/ kg, then the clinical effect was good. The removed efficiency of PSV, PSV+SIMV was significantly better than the other method such as T-tube, CPAP, SIMV, the difference was statistically significant (P < 0.05). Conclusion This paper shows that comprehensive estimate situation, grasp the right opportunity are the important content of the strategic pulled from the machine, and the PSV form has obvious preponderance than other strategies ......
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