自主呼吸试验在慢性阻塞性肺病患者撤离人工气道中的作用

关键词：慢性阻塞性肺病  机械通气  拔出气管插管  自主呼吸试验

Keywords:chronic obstructive palmonary disease  mechanical ventilation  extubation  spontaneous breathing trial

摘要：

      目的：探讨自主呼吸试验（SBT）对机械通气的慢性阻塞性肺病（COPD）患者脱离呼吸机、拔出气管插管时间的影响。方法：采用规范的SBT方法拔出气管插管的COPD患者26例（男性19例，女性7例）列入本研究，作为SBT组。回顾性分析未采用SBT方法拔出气管插管的机械通气COPD患者28 例（男性24例，女性4例），作为No-SBT组。比较两组患者机械通气时间、拔出气管插管时间（拔管时间）,拔管后气管插管复插率（拔出气管插管48h内）心及PaO2,PaCO2血清白蛋白，血红蛋白。结果：两组患者的年龄 (P=0.683)、机械通气时间(P=0.167)差异无显著性，但是SBT组拔出气管插管的时间（60min）与No-SBT组(40—540min)比较差异有显著意义（P=0.0001）。SBT组和No-SBT组患者拔出气管插管后，需无创通气辅助的患者均为3例（P=0.717），48h内再次气管插管患者前者为2例（2/24），后者为3例（3/28）（P=0.900），再次气管插管的原因均为气道分泌物排出不畅。结论：对COPD患者，在撤离呼吸机、拔出气管插管的过程中采用规范SBT方法可以明显地缩短拔管时间，而且未增加气管插管的复插率。

Abstract:

      Objective:To study the effects of spontaneous breathing trial(SBT) in the discontinuing period in mechanically ventilated chronic obstructive pulmonary disease(COPD) patients. Method: Twenty-six COPD patients with protocol-driven extubation strategy with SBT as SBT group (male 19, female 7) were included in the study. Twenty-eight COPD patients (male 24, female 4) without SBT as No-SBT group were retrospected. Duration of mechanical ventilation, reintubation rate(48h after extubation), duration of extubation, PaO2, PaCO2, levels of blood albumin and hemoglobin were compared between the two groups. Result: All the patients in the two groups were similar in age (P=0.683) and mechanical ventilation duration (P=0.167). However, the extubation duration in SBT group (60 min) was significantly different from that (40—540min) in No-SBT group (P=0.0001). In SBT group, 2 patients who failed within 1-hr SBT were excluded from the study. In each group, there were 3 patients required noninvasive ventilation following extubation(P=0.717). Two (2/24) patients in SBT group and 3 (3/28) patients in No-SBT group needed reintubation (P=0.900). Conclusion: The protocol-driven spontaneous breathing trial may shorten the extubation duration in mechanically ventilated COPD patients. Meanwhile, the rate of reintubation does not increased.