自主呼吸试验在急慢性呼吸衰竭患者机械通气撤机过程中的应用

目的评价30min和120min自主呼吸试验(SBT)对急、慢性呼吸衰竭(呼衰)机械通气患者的撤机效果。方法86例急性呼衰患者和53例慢性呼衰患者随机各分为两组,分别以30min SBT和120min SBT完成撤机试验,并对比各组脱机成功率和48h内再插管率。结果慢性呼衰组总脱机成功率75.5%明显低于急性呼衰组的91.9%(P<0.05);总48h内再插管率15.1%则明显高于急性呼衰组的3.5%(P<0.05)。对急性呼衰患者来说,30minSBT组和120minSBT组脱机成功率和48h内再插管率分别为90.7%、93.0%和4.6%、2.3%,两组间差异均无统计学意义(分别P>0.05)。对慢性呼衰患者来说,120minSBT组脱机成功率88.9%明显高于30minSBT组的61.5%(P<0.05);但在48h内再插管率方面,两组间差异无统计学意义(P>0.05)。结论急性呼衰患者选择30minSBT或120minSBT对撤机效果并无影响;而慢性呼衰患者宜选择120minSBT,有利于提高脱机成功率。

Clinical application of spontaneous breathing trial on weaning from mechanical ventilation in patients with acute and chronic respiratory failure

Objective To evaluate the effect of spontaneous breathing trial(SBT) with target durations of 30 and 120 min on weaning from mechanical ventilation in patients with acute and chronic respiratory failure.Methods 86 patients with acute respiratory failure(ARF) and 53 patients with chronic respiratory failure(CRF) were randomly assigned to two groups and a SBT with target durations of 30 and 120 min were performed to these patients.Compared the success rate of weaning and reintubation rate(within 48h) between these two groups.Results The total success rate of weaning in CRF group(75.5%) was obviously lower than that in ARF group(91.9%)(P<0.05),the total reintubation rate(within 48hours) in CRF group(15.1%) was obviously higher than that in ARF group(3.5%)(P<0.05).In patients with ARF,the success rate of weaning and reintubation rate(within 48hours) were 90.7%,93.0% and 4.6%,2.3% in 30minSBT and 120minSBT group respectively,there was no difference in success rate of weaning and reintubation rate(within 48hours) between these two groups(P>0.05).In patients with CRF,the success rate of weaning in 120minSBT group(88.9%) was obviously higher than that in 30minSBT group(61.5%)(P<0.05),but there was no difference in reintubation rate(within 48hours) between these two groups(P>0.05).Conclusions A 30min SBT is equally effective to a 120min SBT on evaluation of weaning from mechanical ventilation in patients with ARF.It is more effective for patients with CRF to accept a 120min SBT for improving the success rate of weaning.