慢性阻塞性肺疾病患者程序化撤机策略的研究

目的探讨慢性阻塞性肺疾病（COPD）程序化撤机策略。方法采用前瞻组性对照研究方法。将COPD机械通气患者分为两组，程序化组采用程序化撤机策略，患者先通过浅快呼吸指数筛选，随即进行自主呼吸试验（SBT），通过SBT患者即可拔除气管插管。非程序化组患者依靠医生的主观判断与临床经验来决定撤离呼吸机的时机。结果程序化组与非程序化组机械通气时间分别为（8．01±7．22）d和（10．74±5．58）d，ICU住院时间分别为（8．86±6．92）d和（12±6．10）d，程序化组明显低于非程序化组（P〈0．05）。程序化组撤机成功率为76．31％，非程序化组为47．36％，差异有统计学意义（P〈0．05）。结论应用程序化撤机策略及SBT方法可以减少COPD患者机械通气时间及住ICU时间，提高撤机的成功率。

Research of sequencing weaning in the patients with chronic obstructive pulmonary disease

Objective To research the sequencing weaning in the patients with chronic obstructive pulmonary disease (COPD). Methods The COPD patients were divided into two groups in this prospective case-control study: protocol-directed group vs none- protocol-directed group. The patients in the former group received programmed ventilator weaning strategy, detaily patients were selected through the shallow breathing with fast exponential screening, then were conducted by spontaneous breathing trial SBT , finally were pulled out the endotracheal intubation. The patients in the latter group were determined the timing of ending the ventilator according to doctors subjective judgment and clinical experience. Results The ventilation time of protocoldirected and on-protocol-directed group was ( 8.01 ± 7. 22 ) and ( 10.74 ± 5.58 ) days ( P = 0. 034 )respectively. ICU stay time was shorter in protocol-directed group than in non-protocol-directed group ( 8.86 ±6.92 vs 12 ±6.10 days, P =0. 026). The success rate of weaning in protocol-directed group was 76.31% (29/38),which was higher than that in non-protocol ～ directed group( 12/25,48% , P = 0. 009 ). Conclusions Protocoldirected weaning and SBT may reduce the ventilation time and ICU stay time and enhance success rate of weaning.