| 两种撤机模式下的危险因素分析及浅快呼吸指数的应用 |
| 投稿时间：2015-04-03 修订日期：2015-04-16 点此下载全文 |
| 引用本文：潘娅静,徐建国,徐敏.两种撤机模式下的危险因素分析及浅快呼吸指数的应用[J].医学研究杂志,2015,44(11):85-88 |
| DOI：
10.11969/j.issn.1673-548X.2015.11.024 |
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| 基金项目:温州市医药卫生科研项目(2013B04) |
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| 中文摘要:目的 探讨导致机械通气患者撤机失败的危险因素及浅快呼吸指数(RSBI)在两种自主呼吸模式下的应用价值。方法 收集笔者医院ICU病房中达到撤机指标患者93例,进行自主呼吸试验(SBT),SBT采用PSV模式和CPAP模式,根据其转归分为成功组和失败组,记录并分析年龄、性别、是否手术、带机时间、HR、MAP、APACHEⅡ评分、ALB、Hb、Cr、SpO2、PaO2、PaCO2、FiO2等指标是否为撤机相关的危险因素。并记录其在两种模式下的呼吸频率、潮气量,计算RSBI(RSBI=f/Vt),分析两种不同模式下RSBI值的差异。同时分别对两组不同模式下成功组和失败组之间的RSBI值进行比较。结果 经多因素Logistic多元回归分析结果显示是否手术,带机时间,APACHEⅡ评分,ALB与撤机成功有相关性(P<0.05)。PSV模式下RSBI值平均为43.850±17.650次/(分·升),CPAP模式下RSBI值平均为50.560±18.772次/(分·升),两者间差异具有统计学意义(P<0.01)。PSV组和CPAP组中,在各自成功组和失败组之间的RSBI值的差异均具有统计学意义(P<0.01)。结论 手术,带机时间,APACHEⅡ评分,ALB属于撤机相关的危险因素。RSBI值在PSV和CPAP两种不同的模式下结果不同,两者间差异有统计学意义,因此认为在不同模式下撤机,不能以单一固定数值指标作为预测值。 |
| 中文关键词:呼吸机撤离 撤机模式 浅快呼吸指数 危险因素 |
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| Analysis of Risk Factors in Two Weaning Modes and the Application of Rapid Shallow Breathe Fast Index. |
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| Abstract:Objective To explore the risk factors leading weaning failure of patients with mechanical ventilation and to investigate the value of rapid shallow breathing index(RSBI) in two different spontaneous breathing trails(SPONT). Methods Totally 93 of patients were weaned from mechanical ventilation through oral intubation.They were performed spontaneous breating test(SBT),and SBT with PSV mode and CPAP mode.All patients were divided into two groups:ventilator weaning success group and ventilator weaning failure group.The following parameters were record and statistical analysis:age, gender,repuiers surgery, mechanical ventilation duration, HR, MAP, APACHE Ⅱ points, ALB, Hb, Cr, FiO2, SpO2, PH, PaO2, PaCO2 and the outher idicators were the risk factorsrelated to ventilator weaning failure. We also recorded respiratory frequency and tidal volume in two modes to calculate RSBI(RSBI=f/Vt) difference. At the same time,we analysised and compared the two different mode RSBI values. Results The results of analysis of multivariate Logistic regression showed that repuiers surgery,mechanical ventilation duration, APACHE Ⅱ points and ALB have correlation with weaning success(P<0.05).The average RSBI was 43.850±17.650bpm/L in PSV mode and 50.560±18.772bpm/L in CPAP mode. Significantly difference was found between the two modes(P<0.01).Both PSV and CPAP modes, had significant difference in RSBI values between weaning success and failure group(P<0.01). Conclusion There existed significant differences in repuiers surgery, mechanical ventilation duration, APACHE Ⅱ points and ALB between weaning success and failure groups. We supposed these indicators were dangerous factors in correlation with weaning success.The results of RSBI in the PSV and the CPAP were different,with a significant difference value between the modes, so as to SBTs ways in the same clinical conditions. This reminded us avoiding using single fixed index as apredictor of weaning. |
| keywords:Ventilator weaning Ventilation mode Rapid shallow breathing index Risk factors |
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