自主呼吸试验在机械通气撤机过程中的应用

目的；探讨在终止机械通气后，自主呼吸试验（SBT）时间对成功拔管的作用。方法：采用回顾组与前瞻组对比的方法，回顾组将成功拔管患者按SBT时间不同及病种不同分别对SBT结果进行记录及统计不处理；前瞻组除慢慢阻塞性肺疾病（COPD）采用1－2小时SBT外，其余病种患者均采用30分钟SBT。记录并比较2组的成功率、再插管率，并进行统计学处理。结果：回顾组患者按时间分组显示，拔管成功率无显著性差异（P＞0.05）；若按病种分别计算，COPD1－2小时组成功率要高于30分钟组（P＜0.05），心力衰竭（心衰）患者30分钟组成功率高于3－4小时组（P＜0.05），与1－2小时组比较无显著性差异（P＞0.05）。前瞻组COPD及心衰组拔管成功率均较回顾组明显提高（P均＜0.05）。结论：应根据不同病种有用不同SBT。COPD患者SBT过短只能了解呼吸肌力，不能了解耐力；而心衰患者SBT过长会增加呼吸功而诱发心衰。

The clinical application of spontaneous breathing trials after weaning of mechanical ventilation

Objective:To investigate the effect of the duration of spontaneous breathing trials (SBT) on the successful extubation after weaning of mechanical ventilation.Methods:In the retrospective group,different durations of SBT in patients with successful extubation were analyzed.In the prospective group,the duration of SBT in COPD patients was controlled to 12 hours and 30 minutes in patients with other diseases.The successful extubation rate and reintubation rate were recorded and compared between the two groups.Results:There were no significant differences in rates of successful extubation for the different durations of SBT in the retrospective group.The successful extubation rate in COPD patients with 12 hours SBT was higher than that of 30 minutes( P <0 05),while the successful extubation rate with 30 minutes SBT in heart failure patients was significant higher than that of 34 hours,but with no significant difference compared with 12 hours( P >0 05 ).The successful extubation rate of COPD and heart failure patients in prospective group was significantly higher than that of the retrospective group (both P <0 05).Conclusions:Different durations of SBT are indicated for patients with different diseases after weaning of mechanical ventilation.