中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2010年
1期
3-5
,共3页
何新飙%赵伟%闫素英%胡轶鹏
何新飆%趙偉%閆素英%鬍軼鵬
하신표%조위%염소영%호질붕
浅快呼吸指数%自动适应性支持通气%呼吸机撤离
淺快呼吸指數%自動適應性支持通氣%呼吸機撤離
천쾌호흡지수%자동괄응성지지통기%호흡궤철리
Rapid - shallow - breathing index%Adaptive support ventilation%Weaning
目的 研究自动适应性支持通气(ASV)和双水平气道正压通气(BiPAP)两种通气模式对撤机后果的影响,并比较常规撤机指标对机械通气患者撤机的预测价值.方法 60例需机械通气的患者随机分两组:ASV组(n=27)和BiPAP组(n=33).床旁监测呼吸频率(RR)、潮气量(VT)、分钟通气量(VE)、阻力(R)、顺应性(C);在自主呼吸试验30 min时分别测定RR、VT并计算浅快呼吸指数(RSB).结果 两组平均带机时间分别为ASV(5.9±2.4)d;BiPAP(6.6±3.0)d.与BiPAP组相比,ASV组患者RSB较低[(68±19)次/(min·L)vs(80±22)次/(min·L),P＜0.05],VT较高[(387±73)ml vs(339±64)ml,P＜0.05)],而撤机成功率无显著性提高(81.5% vs 78.8%,P＞0.05).以撤机后果作为因变量进行Logistic回归分析显示:只有RSB与机械通气时间(DMV)是回归模型中有显著性的两个指标.常规撤机指标RSB、RR、VE和VT的ROC曲线显示RSB的曲线下面积最大.结论 ASV和BiPAP是两种较好的通气模式,二者具有相似的撤机后果.ASV在预防浅快呼吸和操作简单两方面优于BiPAP.RSB在预测撤机后果上优于常规撤机指标,对呼吸机撤离有一定指导意义.
目的 研究自動適應性支持通氣(ASV)和雙水平氣道正壓通氣(BiPAP)兩種通氣模式對撤機後果的影響,併比較常規撤機指標對機械通氣患者撤機的預測價值.方法 60例需機械通氣的患者隨機分兩組:ASV組(n=27)和BiPAP組(n=33).床徬鑑測呼吸頻率(RR)、潮氣量(VT)、分鐘通氣量(VE)、阻力(R)、順應性(C);在自主呼吸試驗30 min時分彆測定RR、VT併計算淺快呼吸指數(RSB).結果 兩組平均帶機時間分彆為ASV(5.9±2.4)d;BiPAP(6.6±3.0)d.與BiPAP組相比,ASV組患者RSB較低[(68±19)次/(min·L)vs(80±22)次/(min·L),P＜0.05],VT較高[(387±73)ml vs(339±64)ml,P＜0.05)],而撤機成功率無顯著性提高(81.5% vs 78.8%,P＞0.05).以撤機後果作為因變量進行Logistic迴歸分析顯示:隻有RSB與機械通氣時間(DMV)是迴歸模型中有顯著性的兩箇指標.常規撤機指標RSB、RR、VE和VT的ROC麯線顯示RSB的麯線下麵積最大.結論 ASV和BiPAP是兩種較好的通氣模式,二者具有相似的撤機後果.ASV在預防淺快呼吸和操作簡單兩方麵優于BiPAP.RSB在預測撤機後果上優于常規撤機指標,對呼吸機撤離有一定指導意義.
목적 연구자동괄응성지지통기(ASV)화쌍수평기도정압통기(BiPAP)량충통기모식대철궤후과적영향,병비교상규철궤지표대궤계통기환자철궤적예측개치.방법 60례수궤계통기적환자수궤분량조:ASV조(n=27)화BiPAP조(n=33).상방감측호흡빈솔(RR)、조기량(VT)、분종통기량(VE)、조력(R)、순응성(C);재자주호흡시험30 min시분별측정RR、VT병계산천쾌호흡지수(RSB).결과 량조평균대궤시간분별위ASV(5.9±2.4)d;BiPAP(6.6±3.0)d.여BiPAP조상비,ASV조환자RSB교저[(68±19)차/(min·L)vs(80±22)차/(min·L),P＜0.05],VT교고[(387±73)ml vs(339±64)ml,P＜0.05)],이철궤성공솔무현저성제고(81.5% vs 78.8%,P＞0.05).이철궤후과작위인변량진행Logistic회귀분석현시:지유RSB여궤계통기시간(DMV)시회귀모형중유현저성적량개지표.상규철궤지표RSB、RR、VE화VT적ROC곡선현시RSB적곡선하면적최대.결론 ASV화BiPAP시량충교호적통기모식,이자구유상사적철궤후과.ASV재예방천쾌호흡화조작간단량방면우우BiPAP.RSB재예측철궤후과상우우상규철궤지표,대호흡궤철리유일정지도의의.
Objective To compare respective effects between adaptive support ventilation (ASV) and biphasic positive airway pressure (BiPAP). The outcome of weaning from mechanical ventilation was compared between the traditional predictors. Methods Sixty patients with respiratory failure were randomly assigned to two weaning techaniques :ASV( n = 27) and BiPAP( n = 33). RR,VT,VE,R, C were measured in 60 cases with mechanical ventilation at the bedside. RR, VT were measured after 30 min of a spontaneous breathing trial and calculated rapid - shallow breathing index ( RSB ). Results The median duration of mechanical ventilation was (5.9 ± 2.4 ) days for ASV and ( 6.6 ± 3.0 ) days for BiPAP. Compared to BiPAP, during ASV patients had lower RSB [( 68 ± 19 ) bpm/L vs ( 80 ± 22 )bpm/L, P ＜0.05)]and higher VT[(387 ±73)ml vs(339 ±64)ml, P ＜0.05)] and no significant increasing in the rate of successful weaning(81.5% vs 78.8% , P ＞0.05). To perform logistic regression analysis with the weaning outcome as the dependent variable, RSB and DMV were the only two significant variables in the model. Area under the ROC curve of RSB was bigger than the other traditional predictors including RR, VT and VE. Conclusions ASV and BiPAP are two of better ventilatory modes and have similartary weaning outcome. ASV is superior to BiPAP in improving RSB and easily to be controlled by clinician. RSB is superior totraditional predictors in predicting weaning outcomes.
