呼吸做功量和吸气时间分数在呼吸机撤离中的应用

目的 通过埘使用机械通气患者撤离呼吸机的临床治疗研究,探究呼吸做功量和吸气时间分数对于呼吸机撤离的临床价值.方法采用前瞻性研究86例2007年1月至2008年1月收治于中国医科大学附属第一医院急诊监护室的患者,满足预设的撤机条件且上机时间不少于72 h的患者的临床资料,然后根据临床确定诊断分为慢性阻塞性肺疾病(COPD)组和急性中毒组,然后COPD组与急性中毒组再根据实际成功撤机与否,分别进一步细分为撤机成功组和失败组,对其相关参数进行统计学分析处理,并与现常规应用的撤机参数进行相火件统计学分析比较,来判断呼吸做功量和吸气时间分数对于预测撤机成功与否的参考价值.结果 撤机成功组与失败组的呼吸做功量相比较可以看出与,WOB<0.75 J/L的现认可的撤机参考结果相近,并且撤机成功组与失败组的患者的心率,机械通气时间,呼吸做功量,吸气时间分数和撤机结果差异具有统计学意义(P<0.05).Logistic回归分析显示呼吸做功量和吸气时间分数对于呼吸机撤机的预测具有一定的临床参考价值(OR值均大于1).结论 呼吸做功量和吸气时间分数作为目前撤机方案的一种补充和完善,需要和其他撤机参数联合使用.目前呼吸机撤离的研究,主要强调的是多项参数的综合性和动态性的联合分析比较,并尝试探寻无创通气代替有创通气的可能,同时也需要医生的有效治疗为根本,给撤机成功提供最大的基础保证.

Application of the work of breathing and Ti/Ttot on weaning of ventilator

Objective To investigate the effects of work of breathing ventilation and Ti/Ttot in the weaning process for patients undergoing mechanical ventilation. Method A prospective analysis was conducted. Eighty-six mechanically ventilated patients, who were admitted for weaning in the intensive care unit from Jan. 2007 to Jan. 2008 were enrolled. The patients in the trial all fulfilled the criteria of discontinuing ventilation and ventilation time no less than 72 hours. According to the diagnosis, they were divided into 2 groups (COPD group and acute toxicoais group). Furthermore according to the outcome of weaning from mechanical ventilation, patients were divided into a failure group and a success group. T-test, chi-square test and logistic regression were used for statistics analysis. Results The results of WOB between the failure group and the success group were approximate to the accepted level(WOB < 0.75 J/L). But there were significant differences on heart rate, ventilation time, WOB and Ti/Ttot between two groups (P <0.05). The logistic regression indicated that the WOB and Ti/Ttot were valuable to pre-dict weaning of ventilator(both OR> 1). Conclusions The parameter of WOB and Ti/Ttot might had a useful ef-fect on weaning of ventilator, but as a supplement it could not evaluate completely by itself, It also needed to com-bine with other parameters. Meanwhile the experience of the duty doctors also had important effects on weaning.