膈肌电活动对慢性阻塞性肺疾病急性加重期插管患者成功撤机的预测价值

目的 探究膈肌电活动对慢性阻塞性肺疾病急性加重期(AECOPD)插管患者撤机的预测价值.方法 选择2013年5月至2015年5月在哈尔滨医科大学附属第一医院行机械通气治疗并考虑撤机的AECOPD插管患者55例作为研究对象,根据患者是否撤机成功将55例AECOPD患者分为撤机成功组与撤机失败组2组.符合撤机条件后,分别对2组患者行自主呼吸试验(SBT) 30 min,分别监测、记录并比较行SBT后0、10及30 min时2组患者膈肌电活动(Edi)、口腔闭合压(P0.1)及呼吸浅快指数(f/Vt),并监测比较2组患者PaCO2、PaO2、MAP及HR等一般情况.结果 55例患者中,撤机成功者35例,占63.6％,撤机失败者20例,占36.4％,2组患者的年龄、PaO2、MAP等一般情况差异均无统计学意义(t=0.078、1.669、1.150,P＞0.05);与撤机失败组相比,撤机成功组患者的PaCO2均明显偏低,差异有统计学意义(t=2.454,P=0.017);行SBT后10 min及30 min时2组患者Edi均显著高于SBT后0 min时相应组别患者的Edi,差异有统计学意义(P＜0.05);行SBT 30 min时,与撤机失败组相比,撤机成功组患者Edi明显偏低,差异有统计学意义(t=3.505,P=0.001);行SBT后10 min及30 min时撤机失败组患者f/Vt较撤机成功组患者高,差异有统计学意义(t=2.624、2.170,P值均＜0.05);与撤机失败组相比,撤机成功组患者P0.1无明显差异,且差异无统计学意义(P＞0.05).结论 Edi对AECOPD插管患者撤机具有较好的预测价值.

The predictive value of electrical activity of diaphragm on weaning of intubated AECOPD patients

Objective To explore the predictive value of electrical activity of diaphragm on weaning of intubated AECOPD patients.Methods Fifty-five AECOPD patients treated with mechanical ventilation and intubation who were consideingr weaning in our in our hospital from May 2013 to May 2015 were selected as the research object and divided into the success group and the failure group based on the success of weaning.Those patients ready to wean were given 30-minute SBT,and their electrical activity of diaphragm (Edi),rapid shallow breathing index (f/Vt) and oral closure pressure (P0.1) were monitored,recorded and compared at the time points of 0,10 and 30 minutes,thire level of blood PaCO2 and PaO2,mean artery pressure (MAP),heart rate (HT) were also monitored,recorded and compared.Results About 55 patients in the study,there 35 patients had successful weaning which accounted for 63.6％ and 20 patients had unsuccessful weaning which accounted for 36.4％.There was no significant difference in age,PaO2 and MAP between the two groups (t =0.078,1.669,1.150,P ＞0.05).The level of blood PaCO2 was obviously higher in the failure group than in the success group,the difference was statistically significant (t =2.454,P =0.017).The value of Edi was obviously higher at the time point of 10 and 30 minutes in the btoh two group than at the time point of 0 minute,The difference was statistically significant (P ＜0.05).The value of Edi was obviously lower at the time point of 30 minutes in the success group when compared with the failure group,The difference was statistically significant (t =3.505,P =0.001).The value of f/Vt was lower in the success group than in the failure group at the time point of 10 and 30 minutes,The difference was statistically significant (t =2.624,2.170,all P ＜0.05).There was no significant difference in the value of P0.1 between two groups,The difference was not statistically significant(P ＞0.05).Conclusions Edi has good predictive value on weaning in AECOPD patients.