机械通气患者不同脱机方法的应用研究

目的机械通气患者不同脱机方法效果比较。方法64例患者均予机械通气支持24h以上。首先应用A／C通气模式进行机械通气，获得适合于患者的基础通气参数、基础血流动力学和氧动力学参数。患者病情稳定并具备撤机条件时，随机选用SIMV＋PSV、Bilevel、VS、PSV＋TC脱机模式，相应分为SIMV＋PSV组、Bilevel组、VS组和PSV＋TC组（每组n=16）。结果四种脱机方式患者的疾病严重度、其VT、f、PaO2／FiO2在四种脱机方式间无显著差异（P〉0．05）。呼吸形式和血气的改变差异也无显著性（P均〉0．05）。Bilevel组、VS组、PSV＋1、C组脱机时间比SIMV＋PSV组短，比较差异有统计学意义。PSV＋TC组脱机时间比Bilevel组、VS组短，比较差异有统计学意义（P〈0．05）。四组再插管率比较差异无统计学意义。结论四种脱机方式中Bilevel、VS和PSV＋TC优于SIMV＋PSV方式，且PSV＋TC最好。

The practical research of different weaning modes applicated to machine ventilated patients

Objective To compare the effect of different weaning modes applied to machine ventilated patients. Methods 64 cases were ventilated by respiratory machine for at least 24 hours. The ventilatory mode was A/C initially. After obtaining the basic ventilatory, hemodynamics and oxygen-dynamics parameter fit to the patients and the patient＇s condition became stable to be weaned from the re- spiratory machine, the ventilarory modes were switched to SIMV ＋ PSV, Bilevel, VS and PSV ＋ TC mode at random. Accordingly, the pa- tients were divided into 4 groups： SIMV ＋ PSV, Bilevel, VS and PSV ＋ TC. Results The disease severity, VT, f, and PaO2/FiO2 had no significant differences among the four groups （ P 〉 0. 05 ）. The change of respiratory style and blood gas analysis had no significant difference （ P 〉 0. 05 ）. The time of weaning machine in Bilevel, VS and PSV ＋ TC groups were shorter than in the SIMV ＋ PSV group. The difference was significant （ P 〈 0. 05 ）. The difference of re-intubate rate among the four groups was not significant （ P 〉 0. 05 ）. Condusion Among the four weaning modes, Bilevel, VS, and PSV ＋ TC were superior to SIMV ＋ PSV and the PSV ＋ TC was the best.