CAJ | 학술논문

目的比较电脑智能脱机、自主呼吸试验(SBT)和经验脱机3种脱机方法对慢性阻塞性肺疾病患者脱机时间和脱机成功率的影响.方法前瞻性临床研究,2005年3月至2008年5月间东南大学附属中大医院68例收住重症医学科(ICU)的COPD机械通气患者纳入观察.随机(随机数字法)分为电脑智能组(24例)、SBT组(24例)和经验组(20例)进行脱机.记录每位患者的脱机时间、总机械通气时间、ICU住院时间以及脱机成功率、住院生存率和机械通气的相关并发症.脱机成功标准为脱机拔管48 h以上未再插管进行机械通气.结果电脑智能组的脱机时间和总机械通气时间均明显低于经验组(P=0.002,0.002),但与SBT组比较差异无统计学意义(P=0.540,0.573).SBT组ICU住院时间(7.5d)明显短于经验组(82.5d) (P=0.015),但SBT组和电脑智能组(8.0 d)以及经验组和电脑智能组比较ICU住院时间差异无统计学意义(P＞0.05).电脑智能组脱机成功率为88.3％,明显高于经验组(50.0％)(P=0.02),但与SBT组(66.7％)比较差异无统计学意义(P＞0.05).ICU住院生存率和总住院生存率3组间比较差异无统计学意义(P＞0.05),再插管率、自行拔管率和无创呼吸机辅助通气率三组间差异亦差异无统计学意义(P＞0.05).结论电脑智能脱机法较经验法能明显提高脱机成功率,但与SBT法相比无优势.
목적 비교전뇌지능탈궤、자주호흡시험(SBT)화경험탈궤3충탈궤방법대만성조새성폐질병환자탈궤시간화탈궤성공솔적영향.방법 전첨성림상연구,2005년3월지2008년5월간동남대학부속중대의원68례수주중증의학과(ICU)적COPD궤계통기환자납입관찰.수궤(수궤수자법)분위전뇌지능조(24례)、SBT조(24례)화경험조(20례)진행탈궤.기록매위환자적탈궤시간、총궤계통기시간、ICU주원시간이급탈궤성공솔、주원생존솔화궤계통기적상관병발증.탈궤성공표준위탈궤발관48 h이상미재삽관진행궤계통기.결과 전뇌지능조적탈궤시간화총궤계통기시간균명현저우경험조(P=0.002,0.002),단여SBT조비교차이무통계학의의(P=0.540,0.573).SBT조ICU주원시간(7.5d)명현단우경험조(82.5d) (P=0.015),단SBT조화전뇌지능조(8.0 d)이급경험조화전뇌지능조비교ICU주원시간차이무통계학의의(P＞0.05).전뇌지능조탈궤성공솔위88.3％,명현고우경험조(50.0％)(P=0.02),단여SBT조(66.7％)비교차이무통계학의의(P＞0.05).ICU주원생존솔화총주원생존솔3조간비교차이무통계학의의(P＞0.05),재삽관솔、자행발관솔화무창호흡궤보조통기솔삼조간차이역차이무통계학의의(P＞0.05).결론 전뇌지능탈궤법교경험법능명현제고탈궤성공솔,단여SBT법상비무우세.
Objective To compare the outcomes of 3 modes of weaning,e.g.SmartCare (a computerdriven knowledge-based system),spontaneous breathing trials (SBBT) and empirical methods,used in patients with chronic obstructive pulmonary diseases (COPD) weaned off mechanical ventilation.Methods Sixty-eight COPD patients were enrolled and randomly (random number) assigned to receive SmartCare (SC group,n =24),SBT (SBT group,n=24) or empirical methods (EM group,n =20).The following data were recorded including beginning of weaning:time consumed for weaning,duration of mechanical ventilation,length of ICU stay,success rate of weaning,survival rate during hospitalization and the complications of mechanical ventilation.The patients were considered as successfully weaned when they were able to tolerate at least 48 consecutive hours of spontaneous breathing.Results Time required for weaning and total time for mechanical ventilation in SC group were greatly shorter than those in EM group (P =0.002,0.002),but there were no differences between SC group and SBT group (P =0.540,0.573).Though the length of ICU stay (7.5 d) in SBT group was notably shorter than that in EM group (82.5 d) (P=0.015),there was no difference between SBT group and SC group (8.0 d).Weaning success rate was greater in the SC group (88.3％) than that in EM group (50.0％),but there was no difference between SBT group (66.7％ ) and SC group.No significant differences in survival rate during hospitalization,rate of re-intubation,self-extubation and need for noninvasive ventilation were found among three groups.Conclusions Compared to empirical methods for weaning,SmartCare could greatly increase the success rate of weaning,but it was not superior to SBT.