中国基层医药
中國基層醫藥
중국기층의약
CHINESE JOURNAL OF PRIMARY MEDICINE AND PHARMACY
2015年
8期
1121-1124
,共4页
通气,人工%肺疾病,慢性阻塞性%肺部感染%呼吸试验
通氣,人工%肺疾病,慢性阻塞性%肺部感染%呼吸試驗
통기,인공%폐질병,만성조새성%폐부감염%호흡시험
Ventilation,artificial%Pulmonary disease,chronic obstructive%Pulmonary infection%Breath test
目的：评估慢性阻塞性肺疾病急性加重（AECOPD）患者在肺部感染控制（PIC）窗能否独立呼吸以及拔管后使用无创正压通气（NPPV）的必要性。方法采用前瞻性研究，使用自主呼吸试验（SBT）评估AECOPD行IPPV患者能否在PIC窗独立呼吸。根据SBT结果分为SBT失败组和SBT通过组，SBT失败的患者使用NPPV，SBT通过的患者接受氧疗，出现呼吸窘迫时转为NPPV。记录SBT通过组和失败组患者呼吸、循环指标，拔管72 h内需要NPPV的患者数量和再插管率。结果共23例患者纳入研究，15例（65．2％）通过SBT，其中12例（80．0％）拔管后出现呼吸衰竭并需要NPPV（1例需再插管）。8例患者SBT失败，1例行NPPV后需再插管。拔管72 h后再插管率SBT通过组为7．0％，低于SBT失败组的13．0％，但差异无统计学意义（χ2＝1．476，P＞0．05）。结论多数AECOPD患者在PIC窗有独立呼吸能力，但是绝大多数患者发展为呼吸窘迫。因此，拔管后有必要行NPPV。
目的：評估慢性阻塞性肺疾病急性加重（AECOPD）患者在肺部感染控製（PIC）窗能否獨立呼吸以及拔管後使用無創正壓通氣（NPPV）的必要性。方法採用前瞻性研究，使用自主呼吸試驗（SBT）評估AECOPD行IPPV患者能否在PIC窗獨立呼吸。根據SBT結果分為SBT失敗組和SBT通過組，SBT失敗的患者使用NPPV，SBT通過的患者接受氧療，齣現呼吸窘迫時轉為NPPV。記錄SBT通過組和失敗組患者呼吸、循環指標，拔管72 h內需要NPPV的患者數量和再插管率。結果共23例患者納入研究，15例（65．2％）通過SBT，其中12例（80．0％）拔管後齣現呼吸衰竭併需要NPPV（1例需再插管）。8例患者SBT失敗，1例行NPPV後需再插管。拔管72 h後再插管率SBT通過組為7．0％，低于SBT失敗組的13．0％，但差異無統計學意義（χ2＝1．476，P＞0．05）。結論多數AECOPD患者在PIC窗有獨立呼吸能力，但是絕大多數患者髮展為呼吸窘迫。因此，拔管後有必要行NPPV。
목적：평고만성조새성폐질병급성가중（AECOPD）환자재폐부감염공제（PIC）창능부독립호흡이급발관후사용무창정압통기（NPPV）적필요성。방법채용전첨성연구，사용자주호흡시험（SBT）평고AECOPD행IPPV환자능부재PIC창독립호흡。근거SBT결과분위SBT실패조화SBT통과조，SBT실패적환자사용NPPV，SBT통과적환자접수양료，출현호흡군박시전위NPPV。기록SBT통과조화실패조환자호흡、순배지표，발관72 h내수요NPPV적환자수량화재삽관솔。결과공23례환자납입연구，15례（65．2％）통과SBT，기중12례（80．0％）발관후출현호흡쇠갈병수요NPPV（1례수재삽관）。8례환자SBT실패，1례행NPPV후수재삽관。발관72 h후재삽관솔SBT통과조위7．0％，저우SBT실패조적13．0％，단차이무통계학의의（χ2＝1．476，P＞0．05）。결론다수AECOPD환자재PIC창유독립호흡능력，단시절대다수환자발전위호흡군박。인차，발관후유필요행NPPV。
Objective To assess whether AECOPD patients can breathe independently at the PIC window and thus whether NPPV was necessary after extubation.Methods We performed a prospective observational study, we used the spontaneous breathing trial (SBT)to assess whether each patient could breathe independently at the PIC window,then performed extubation.Patients who passed the SBT received oxygen therapy only,whereas those who failed received NPPV.However,if the former showed respiratory distress,they also received NPPV.The primary out-come variables were SBT pass/fail,the demand for NPPV and rate of reintubation within 72h following extubation. Results In all,23 patients were enrolled,15cases(65.2%)of which passed the SBT.Of these,12cases (80.0%) patients developed respiratory distress after extubation and required NPPV (one of whom required reintubation).Of the eight patients that failed,one received reintubation after NPPV.The reintubation rates within 72h following extuba-tion of SBT-pass(7.0%)and SBT-fail (13.0%)(χ2 =1.476,P>0.05)patients were comparable.Conclusion Most AECOPD patients can breathe independently at the PIC window,but nonetheless develop respiratory distress and thus require NPPV following extubation.
