CAJ | 학술논문

目的分析机械通气患儿呼吸机撤离失败率及失败的相关因素.方法回顾分析我院2005年1月至2008年12月内科重症监护室收治的机械通气患儿214例,统计撤机失败率,分析撤机失败的相关因素.结果 141例患儿按计划撤机,成功122例,失败19例,撤机失败率13.5%.年龄＜6个月患儿撤机失败率较年龄＞6个月患儿高,但差异无显著性(15.0% vs9.8%,P＞0.05).因肺炎进行机械通气的患儿撤机成功率(78/86,90.7%)最高.机械通气时间对撤机成功与否无影响.撤机后皮质激素应用时间成功组短于失败组,差异有显著性[(12.35±9.69)h vs(18.63±12.17)h,P＜0.05).多元线性逐步回归(R2=0.093)分析提示呼吸道梗阻是撤机失败的高危因素(F=14.256,P＜0.001).结论目前PICU中机械通气患儿的撤机问题还依赖于临床医生的经验和客观指标相结合,探索合理可行的撤机方案,尽早发现和去除引起撤机失败的因素是提高撤机成功率的关键.
목적 분석궤계통기환인호흡궤철리실패솔급실패적상관인소.방법 회고분석아원2005년1월지2008년12월내과중증감호실수치적궤계통기환인214례,통계철궤실패솔,분석철궤실패적상관인소.결과 141례환인안계화철궤,성공122례,실패19례,철궤실패솔13.5%.년령＜6개월환인철궤실패솔교년령＞6개월환인고,단차이무현저성(15.0% vs9.8%,P＞0.05).인폐염진행궤계통기적환인철궤성공솔(78/86,90.7%)최고.궤계통기시간대철궤성공여부무영향.철궤후피질격소응용시간성공조단우실패조,차이유현저성[(12.35±9.69)h vs(18.63±12.17)h,P＜0.05).다원선성축보회귀(R2=0.093)분석제시호흡도경조시철궤실패적고위인소(F=14.256,P＜0.001).결론 목전PICU중궤계통기환인적철궤문제환의뢰우림상의생적경험화객관지표상결합,탐색합리가행적철궤방안,진조발현화거제인기철궤실패적인소시제고철궤성공솔적관건.
Objective To analyze the failure rate and failure factors related to ventilator weaning off in children. Methods Clinical data of 214 patients who received mechanical ventilation in pediatric intensive care unit of Tianjin Children's Hospital from Jan 2005 to Dec 2008 were analyzed retrospectively. Results There were 141 planned extubation events,122 of which were successful and 19 of which were unsuccessful.The failure rate of planned extubation was 13.5%. The failure rate of infants less than 6 months was higher than that of infants more than 6 months, but there was no significant difference ( 15.0% vs 9. 8%, P ＞0.05). The success rate of extubation in pneumonia cases (90. 7% )was higher than that in others (P ＜0. 05 ). The duration of mechanical ventilation had no effect on success rate of extubation ( (7. 64 ± 5.68 ) d vs (6. 95 ± 3. 14) d, P ＞ 0. 05 ). The duration of corticosteroid treatment after extubation in the successful group was less than that in the failure group ( ( 12. 35 ±9. 69) h vs ( 18.63 ± 12. 17) h,P ＜0. 05). According to the result of multiple linear regression analysis ( R2 = 0. 093), airway obstruction was the high risk factor of the extubation failure( F = 14. 256, P ＜ 0. 001 ). Conclusion Currently,weaning from mechanical ventilation in PICU depends on the combination of pediatricians' experience and objective indicators. The key point for improving the success rate of exubation is that we should explore reasonable and feasible extubation protocol and discover and exclude the related factors of exubation failure as earlier as possible.