氧代谢指标检测对有创-无创序贯机械通气的指导价值

目的探讨临床检测氧代谢指标在机械通气患者呼吸机撤离时机把握中的应用价值，为指导临床撤机时机提供依据。方法32例慢性阻塞性肺病（chronic obstructive pulmonary diseases，COPD）并发呼吸衰竭患者给予有创机械通气治疗后准备转无创机械通气，依据撤机成功或失败分为序贯成功组22例和序贯失败组10例。全程监测血乳酸、中心静脉血氧饱和度（ScvO2），并进行急性生理和慢性健康评分（APACHEII）。结果序贯成功组血乳酸和ScvO2均在正常范围内，序贯失败组血乳酸高于正常，ScvO2〈70％；序贯成功组撤机前血乳酸水平与APACHEII呈正相关，ScvO2与APACHEII呈负相关。结论COPD患者在肺部感染控制窗出现的同时监测氧代谢指标有助于指导有创一无创序贯机械通气，提高患者脱机成功率，减低再插管率。

The guiding value of oxygen metabolism detection for changing from invasive to non-invasive mechanical ventilation

To explore the guiding value of oxygen metabolism detection for determination of an appropriate time in which patients could be changed from invasive to non-invasive mechanical ventilation.Thirty-two patients with chronic obstructive pulmonary diseases(COPD) were divided into two groups:sequential therapeutic success(n = 22) and sequential therapeutic failure(n = 10) according to the final clinic outcome.The blood lactate,central venous oxygen saturation(ScvO2) and APACHEⅡ were monitored during the whole course.Both plasma lactate and ScvO2 returned to normal range at 2h before endotracheal intubation was removed in sequential therapeutic success group,while the indexes did not in the sequential failure group.Correlation and regression analysis showed that blood lactate,ScvO2 has the positive and negative correlation with APACHEⅡ,respectively.Monitoring oxygen metabolism can guide when COPD patients could be changed from invasive to non-invasive mechanical ventilation within pulmonary infection control window.That may improve the success rate of the sequential therapy and reduce the rate of reintubation.