观察导管补偿模式(TC)行自主呼吸试验(SBT)对呼吸衰竭患者拔管成功率的影响
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摘要
目的探讨导管补偿模式(TC)下,达到拔出气管插管指证的患者,实行自主呼吸试验(SBT),对其拔管成功率的影响。方法选取2015. 5月-2017. 9月在济宁市第一人民医院重症监护二区住院治疗的45例机械通气患者,随机分成ATC组(25例)和PSV组(20例),根据指南治疗后病情稳定,并达到拔管指证。ATC组采用自动导管补偿模式,PSV组应用低水平压力(PS 8cmH_2O),各自进行自主呼吸试验(SBT) 1h,结束后,检测并记录以下通气参数:潮气量(V_T)、气道峰压(PIP)、呼吸频率(RR)、血氧饱和度(SaO_2)、气道闭合压(P0. 1)、最大吸气压(Pimax)和呼吸浅快指数(RSBI),比较两组患者各呼吸力学参数的差异。结果 ATC组患者的P0. 1、Pimax、RSBI和RR高于PSV组,有统计学差异(P <0. 05),而PIP、V_T和SaO_2与PSV组无统计学差异(P> 0. 05)。结论对于预拔管的呼吸衰竭患者,采用ATC法进行自主呼吸试验时,较应用低水平PSV试验通气模式拔管成功率更高。
Objective To observe the effect of catheter compensation mode( TC) spontaneous breathing test( SBT) on the success rate of extubation in patients with respiratory failure. Methods A total of 45 patients with respiratory failure who had been mechanically ventilated for more than 72 h were hospitalized in ICU of Jining first people's Hospital from May 2015 to September 2017. They were randomly divided into the ATC group( 25 cases) and the PSV group( 20 cases). After comprehensive treatment,the condition was stable and had already been extubated.The ATC group was given automatic tube compensation( compensation ratio of 100%),and the PSV group was given low level pressure( PS 8 cm H2O). After 1-hour independent breath test,their ventilation tidal volume( V_T),peak airway pressure( PIP),respiratory rate( RR),oxygen saturation( SaO_2),airway occlusion pressure( P0. 1),maximal inspiratory pressure( Pimax) and rapid shallow breathing index( RSBI) were recorded and compared between the two groups. Results The value of P0. 1,Pimax,RSBI and RR in the ATC group were higher than those in the PSV group( P < 0. 05),while PIP,V_Tand SaO_2 showed no significant difference between the two groups( P >0. 05). Conclusion For patients with prepullable respiratory failure,the successful rate of tube extubation is higher than that in the low level PSV test ventilation model when the ATC method is used for spontaneous breathing test.
Objective To observe the effect of catheter compensation mode( TC) spontaneous breathing test( SBT) on the success rate of extubation in patients with respiratory failure. Methods A total of 45 patients with respiratory failure who had been mechanically ventilated for more than 72 h were hospitalized in ICU of Jining first people's Hospital from May 2015 to September 2017. They were randomly divided into the ATC group( 25 cases) and the PSV group( 20 cases). After comprehensive treatment,the condition was stable and had already been extubated.The ATC group was given automatic tube compensation( compensation ratio of 100%),and the PSV group was given low level pressure( PS 8 cm H2O). After 1-hour independent breath test,their ventilation tidal volume( V_T),peak airway pressure( PIP),respiratory rate( RR),oxygen saturation( SaO_2),airway occlusion pressure( P0. 1),maximal inspiratory pressure( Pimax) and rapid shallow breathing index( RSBI) were recorded and compared between the two groups. Results The value of P0. 1,Pimax,RSBI and RR in the ATC group were higher than those in the PSV group( P < 0. 05),while PIP,V_Tand SaO_2 showed no significant difference between the two groups( P >0. 05). Conclusion For patients with prepullable respiratory failure,the successful rate of tube extubation is higher than that in the low level PSV test ventilation model when the ATC method is used for spontaneous breathing test.
引文
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[12]龚昭惠,谭娟.自主呼吸试验在机械通气撤机过程中的应用价值[J].临床肺科杂志,2014,19(6):1105-1106.
[13]刘旭,张继先,谢姣,等.自主呼吸试验在COPD机械通气患者撤机中的作用[J].临床肺科杂志,2013,18(4):651-652.
[2]RUTOS-VIVAR F,ESTEBAN A.When to wean from a ventilator:an evidence-based strategy[J].Cleve Clin J Med,2003,70(5):389,392-393,397.
[3]UNOKI T,SERITA A,GRAP M J.Automatic tube compensation during weaning from mechanical ventilation:evidence and clinical implications[J].Crit Care Nurse,2008,28(4):34-43.
[4]GUTTMANN J,HABERTHR C,MOLS G.Automatic tube compensation[J].Respir Care Clin N Am,2001,7(3):475-501.
[5]FIGUEROA-CASAS J B,MONTOYA R,ARZABALA A,et al.Comparison between automatic tube compensation and continuous positive airway pressure during spontaneous breathing trials[J].Respir Care,2010,55(5):549-554.
[6]MACINTYRE N R,COOK D J,ELY E W JR,et al.Evidencebased guidelines for weaning and discontinuing ventilatory support:a collective task force facilitated by the American College of Chest Physicians;the American Association for Respiratory Care;and the American College of Critical Care Medicine[J].Chest,2001,120(S6):S375-S395.
[7]ESTEBAN A,ALIA I,GORDO F,et al.Extubation outcome after spontaneous breathing trials with T-Tube or pressure support ventilation[J].Am J Respir Crit Care Med,1997,156(2 Pt 1):459-465.
[8]陈宇清,陈钦,周新.自动导管阻力补偿技术联合压力支持通气对撤机患者呼吸力学参数的影响[J].生物医学工程与临床,2009,13(4):328-331.
[9]BONETTO C,CAL M N,DELGADO M O,et al.Modes of pressure delivery and patient-ventilator interaction[J].Respir Care Clin NAm,2005,11(2):247-263.
[10]COHEN J D,SHAPIRO M,GROZOVSKI E,et al.Automatic tube compensation-assisted respiratory rate to tidal volume ratio improves the prediction of weaning outcome[J].Chest,2002,122(3):980-984.
[11]HABERTHR C,FABRY B,STOCKER R,et al.Additional inspiratory work of breathing imposed by tracheostomy tubes and nonideal ventilator properties in critically ill patients[J].Intensive Care Med,1999,25(5):514-519.
[12]龚昭惠,谭娟.自主呼吸试验在机械通气撤机过程中的应用价值[J].临床肺科杂志,2014,19(6):1105-1106.
[13]刘旭,张继先,谢姣,等.自主呼吸试验在COPD机械通气患者撤机中的作用[J].临床肺科杂志,2013,18(4):651-652.