自主呼吸试验通过后拔管失败原因分析

目的:分析通过自主呼吸试验(SBT)后拔管失败的原因,提高撤机拔管的成功率。方法:回顾性分析重症监护病房(ICU)接受机械通气并通过SBT后拔管的126例患者的临床资料及其拔管失败原因。结果:拔管失败28例(22.22%),因呼吸系统原因导致拔管失败15例,其中气道分泌物过多且喘憋加重14例,呼吸骤停1例;低氧血症7例;呼吸性酸中毒3例,其中喉水肿1例,支气管狭窄1例;意识障碍加重3例,其中脑出血1例。拔管失败患者中,血白蛋白水平是拔管失败后患者病死率的保护因素。结论:仅通过SBT来指导撤机拔管可能有一定的局限性,除了呼吸系统原因外,氧合状态、中枢神经系统、营养状态等都可能对拔管结局产生影响,因此对于通过SBT进行脱机拔管的患者,仍应该充分评估呼吸道、中枢神经、心功能以及营养状态等多方面因素。

Analysis of extubation failure after a spontaneous breathing test

Objective: To analyze the reasons for the failure of extubation after spontaneous breathing test (SBT) and to improve the success rate of extubation. Methods: The clinical data of 126 patients who underwent mechanical ventilation and who underwent extubation after SBT in the intensive care unit (ICU) and the causes of extubation failure were retrospectively analyzed. Results: Twenty-eight patients (22.22%) had extubation failure. Of them 15 patients had extubation failure due to respiratory system, including 14 cases of airway secretion and respiratory surge, 1 case of respiratory arrest. There were 7 cases of hypoxemia, 3 cases of respiratory acidosis, including 1 case of laryngeal edema, 1 case of bronchoconstriction. There were 3 cases of increased consciousness disorder, including 1 case of cerebral hemorrhage. In patients with extubation failure, serum albumin levels were a protection factor for mortality in patients with extubation failure. Conclusion: SBT alone can be used to guide the withdrawal of the tube, but there may be some limitations in the removal of the tube. In addition to the respiratory system, the oxygenation state, the central nervous system, and the nutritional status may affect the extubation outcome. In the patients with mechanical extubation, the respiratory tract, central nervous system, cardiac function and nutritional status should be still fully evaluated.