浅快呼吸指数指导缺血性脑卒中患者撤机的临床观察

目的探讨浅快呼吸指数(RSBI)指导缺血性脑卒中患者撤机的临床价值。方法前瞻性研究,入选在重症医学科进行有创机械通气24 h 40例缺血性脑卒中患者,根据撤机结果将患者分为成功组26例,失败组14例。应用低水平压力支持通气法进行自主呼吸实验(SBT),40例患者均通过了1 h的自主呼吸实验,记录SBT前和SBT1h、SBT1.5h及SBT2h的RSBI,同时记录年龄、性别、APACHEⅡ评分、撤机前30 min的血气分析。结果成功组和失败组年龄、性别、GCS评分、APACHEⅡ评分无明显差异(P0.05),失败组合并冠心病比例较成功组明显升高(P0.05)。以RSBI≤105 bpm/L为标准预测撤机成功的灵敏度和特异度分别为:SBT前93.8%、10.6%,SBT1 h 100%、40.24%、SBT1.5 h 98.2%、38.7%SBT2 h 96.3%、38.2%。结论SBT1 h的RSBI预测缺血性脑卒中患者撤机成功的准确率高。动态观察RSBI对缺血性脑卒中患者成功撤机有一定的预测价值。

Clinical observation of rapid-shallow breathing index to guide weaning for patients with ischemic cerebral apoplexy

Objective To explore the application value of rapid-shallow breathing index （ RSBI） to guide weaning from mechanical ventilation for patients with ischemic cerebral apoplexy. Methods 40 patients with ische-mic stroke in ICU were divided into two groups according to the result of weaning from mechanical ventilation, 26 ca-ses in the success group and 14 cases in the failure group. The low level pressure support ventilation method was ap-plied to spontaneous breathe test （ SBT） . All patients were given 1-hour SBT to record RSBI, as well as their age, sex, APACHEⅡscore, and blood gas analysis 30 minutes before weaning. Results There was no significant differ-ence in age, gender, GCS score and APACHEⅡscore between the two groups （P＆gt;0. 05）. The incidence of coro-nary heart disease was significantly higher in the success group than in the failure group （P＆lt;0. 05）. Taking RSBI≤105 bpm/L as the prediction standard, the sensitivity and specificity were 93. 8% and 10. 6% before SBT, 100%and 40. 24% 1hour after SBT, 98. 2% and 38. 7% 1. 5 hours after SBT, and 96. 3% and 38. 2% 2 hour after SBT, respectively . Conclusion RSBI 1 hour after SBT has the highest sensitivity and specificity of weaning from mechani-cal ventilation for patients with ischemic cerebral apoplexy, and the dynamic observation of RSBI has a certain predic-tive value on weaning from mechanical ventilation for patients with ischemic cerebral apoplexy.