不同自主呼吸试验模式对呼吸衰竭患者撤机拔管成功率及呼吸机相关性肺炎发生率的影响分析
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摘要
目的:分析不同自主呼吸试验(SBT)模式对呼吸衰竭患者撤机拔管成功率和呼吸机相关肺炎发生率的影响程度,探讨导管补偿(TC)模式的临床应用价值。方法:回顾性分析326例呼吸衰竭患者资料,根据SBT模式的不同将其分为观察组和对照组,每组163例。观察组采用TC模式进行SBT,对照组采用压力支持通气(PSV)模式进行SBT。观察撤机拔管患者24 h内临床症状,统计再次插管和呼吸机相关肺炎患者的比例,并观察分析两组撤机拔管治疗效果的差异性。结果:观察组中SBT成功138例,撤机拔管后48 h内再次插管4例,呼吸机相关肺炎患者8例;对照组中SBT成功154例,撤机拔管后48 h内再次插管19例,呼吸机相关肺炎患者20例,两组患者的撤机拔管成功率比较,差异有统计学意义(x~2=7.42,P<0.05);呼吸机相关肺炎发生率比较,差异有统计学意义(x~2=4.34,P<0.05)。结论:TC模式在预测撤机拔管成功率方面优于PSV模式,同时可以有效的控制呼吸机相关肺炎发生率,在提高临床治疗效果和呼吸机使用管理方面具有较高的应用价值。
Objective: To analyze the impact degree of different spontaneous breathing trial(SBT) modes on the success rate of weaning and extubation of ventilator and the incidence rate of ventilator-associated pneumonia on patients with respiratory failure so as to investigate the clinical application value of tube compensation(TC) mode.Methods: The data of 326 patients with respiratory failure were retrospectively analyze, and these patients were divided into observation group and control group according to different SBT modes, 163 cases in each group. TC mode was used in observation group to implement SBT, and pressure supported ventilation(PSV) mode was used in control group to implement SBT. The clinical symptoms of patients within 24 hours post weaning and extubation were observed. And the proportion of re-intubation and the proportion of patients with ventilator-associated pneumonia were calculated as statistic method. Besides, the differences of curative effect of weaning and extubation between two groups were observed and analyzed. Results: In the observation group, 138 cases succeeded in SBT, and 4 cases had the intubation again within 48 hours post the weaning and extubation, and 8 cases occurred ventilator-associated pneumonia. The corresponding numbers of patients in the control group were 154, and 19 cases were intubation again within 48 h post weaning and extubation, and the number of patients with ventilator-associated pneumonia was 20 cases.The difference of the success rate of the weaning and extubation between the two groups was significant(x~2=4.34,P<0.05). And the difference of incidence rate of ventilator-associated pneumonia was significant(x~2=4.34, P<0.05).Conclusion: TC mode is better in predicting the successful rate of weaning and extubation than that of PSV mode.At the same time, it can effectively control the incidence rate of ventilator-associated pneumonia, and it has higher application value in improving the clinical therapeutic effect and the use management of ventilator.
Objective: To analyze the impact degree of different spontaneous breathing trial(SBT) modes on the success rate of weaning and extubation of ventilator and the incidence rate of ventilator-associated pneumonia on patients with respiratory failure so as to investigate the clinical application value of tube compensation(TC) mode.Methods: The data of 326 patients with respiratory failure were retrospectively analyze, and these patients were divided into observation group and control group according to different SBT modes, 163 cases in each group. TC mode was used in observation group to implement SBT, and pressure supported ventilation(PSV) mode was used in control group to implement SBT. The clinical symptoms of patients within 24 hours post weaning and extubation were observed. And the proportion of re-intubation and the proportion of patients with ventilator-associated pneumonia were calculated as statistic method. Besides, the differences of curative effect of weaning and extubation between two groups were observed and analyzed. Results: In the observation group, 138 cases succeeded in SBT, and 4 cases had the intubation again within 48 hours post the weaning and extubation, and 8 cases occurred ventilator-associated pneumonia. The corresponding numbers of patients in the control group were 154, and 19 cases were intubation again within 48 h post weaning and extubation, and the number of patients with ventilator-associated pneumonia was 20 cases.The difference of the success rate of the weaning and extubation between the two groups was significant(x~2=4.34,P<0.05). And the difference of incidence rate of ventilator-associated pneumonia was significant(x~2=4.34, P<0.05).Conclusion: TC mode is better in predicting the successful rate of weaning and extubation than that of PSV mode.At the same time, it can effectively control the incidence rate of ventilator-associated pneumonia, and it has higher application value in improving the clinical therapeutic effect and the use management of ventilator.
引文
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[12]陆粉花.对使用呼吸机的患者进行预防并发症护理的效果分析[J].当代医药论丛,2015,13(17):71-72.
[2]张凌雁.无创正压机械通气不同的通气模式治疗慢阻肺急性加重期呼吸衰竭的疗效对比分析[J].世界复合医学,2018,4(1):64-66.
[3]Li CN,Chen L,Ge YP,et al.Risk factors for prolonged mechanical ventilation after total aortic arch replacement for acute DeBakey type I aortic dissection[J].Heart Lung Circ,2014,23(9):869-874.
[4]韩兰萍,尹育红,江萍,等.COPD病人应用无创呼吸机治疗过程中出现并发症的原因分析及护理对策[J].全科护理,2017,15(16):1958-1960.
[5]Rees SE,Karbing DS.Determining the appropriate model complexity for patient-specific advice on mechanical ventilation[J].Biomed Tech(Berl),2017,62(2):183-198.
[6]李炜,周婷.不同自主呼吸试验方法在气管插管患者撤机时的应用[J].上海护理,2016,16(3):22-25.
[7]刘行仁.有创机械通气治疗的AECOPD患者撤机困难相关影响因素分析[J].中国医疗器械信息,2018,24(2):3-5.
[8]乔智灏,贾树宝,董慧青.老年COPD急性加重期患者自主呼吸试验通过后拔管失败原因分析[J].中国全科医学,2015,18(17):2074-2077.
[9]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.
[10]Cohen R,Shimoni Z,Ghara R,et al.Effect of a ventilator-focused intervention on the rate of Acinetobacter baumannii infection among ventilated patients[J].Am J Infect Control,2014,42(9):996-1001.
[11]罗蓝,杨相宜,王秀芬.护理风险干预对ICU呼吸窘迫患者呼吸机相关肺炎并发症的影响[J].中医临床研究,2017,9(33):23-25.
[12]陆粉花.对使用呼吸机的患者进行预防并发症护理的效果分析[J].当代医药论丛,2015,13(17):71-72.