呼吸功与气道闭和压对老年慢性阻塞性肺病撤机的指导作用研究

目的:探讨呼吸功(WOB)和气道闭和压(P0.1)对老年慢性阻塞性肺病患者撤机的指导作用。方法:选择老年慢性阻塞性肺病患者机械通气并准备撤机的28例患者应用BICORE-CP100呼吸监测仪床边监测病人WOB、气道闭和压(P0.1)及常规撤机指标潮气量(VT)、呼吸频率(RR)、每分钟通气量(VE)、最大吸气压(MIP)、氧合指数(PO2/FiO2)及APACH评分,观察撤机成功与失败呼吸功值和常规撤机指标及APACH评分相互比较。结果:撤机成功23例,WOB0.95±0.24J/L,其中15例WOB值<0.75J/L,8例WOB在0.94～1.39J/L之间,P0.1值0.24±0.05kPa。撤机失败5例WOB值1.92±0.47J/L,P0.1值0.46±0.07kPa。撤机失败组WOB、P0.1、RR、MIP、VE、PO2/FiO2、APACH评分均明显高于成功组(P<0.05),VT明显低于成功组(P<0.05)。结论:WOB和P0.1值对撤机都有指导作用,单一指标并非敏感,应结合临床综合指标更为可靠。

Work of breathing and airway occlusion pressure as a weaning parameter in elderly chronic obstructive pulmonary disease

Objective：To evaluate the work of breathing（WOB）and airway occlusion pressure（P0.1）as a predictive measure of weaning in patients with mechanical ventilation.Methods：WOB,P0.1 and standard weaning criteria（respiratory rate,tidal volume,ventilation volume perminute,maximal inspiratory pressure,arterial partial pressure of oxygen/fractional concentration of O2 in inspired gas）and APACHⅡscoring,to observe succeed groups and failed groups WOB and standard weaning criteria and APACHⅡscoring mutual comparison.Results：23case succeed,WOB rise（0.95±1.24J/L）.15 of which WOB normal（0.75J/L）,8 of which WOB rise（0.94~1.39J/L）.P0.1 rise 0.24±0.05kPa.5 of which WOB failed（1.92±0.47J/L）,P0.1 rise 0.46±0.07kPa.Failed groups WOB,P0.1,RR,MIP,VE,PO2/FiO2,APACHⅡscoring were significantly higher than successful groups（P0.05）,VT was significantly lower than successful groups（P0.05）.Conclusions：WOB and P0.1 alone is inadequate as a weaning indicator,it is necessary to make a decision of weaning by WOB and P0.1,and more reliableif combined with clinical indications.