论文部分内容阅读
目的评价程序化撤机协议在急诊ICU中减少机械通气时间和降低机械通气并发症等方面的价值。方法对中南大学附属湘雅医院急诊重症监护室(EICU)79例实施了气管插管或气管切开并进行机械通气的病人进行随机化分组。协议组按照程序化撤机协议的流程每日进行自主呼吸功能评测,达到评测标准的病人进行2h的自主呼吸试验(SBT),成功完成SBT的病人将撤离呼吸机。对照组按照常规撤机方法撤离呼吸机。结果协议组病人的机械通气时间(中位数为4d)比对照组(中位数为6d)更短(P=0.032)。Kaplan-Meier生存分析和Cox proportional-hazards回归模型显示协议组比对照组更早脱离呼吸机(RR=1.82,95%CI为1.03～3.34,P=0.041)。SBT期间未发生任何并发症。协议组机械通气期间并发症的发生率比对照组低(P<0.01)。结论在急诊监护室中使用程序化撤机协议能够减少机械通气时间并降低并发症发生率。
Objective To evaluate the value of procedural weaning protocol in reducing the duration of mechanical ventilation and reducing the complications of mechanical ventilation in emergency ICU. Methods 79 patients with emergency intensive care unit (EICU) of Xiangya Hospital Affiliated to Central South University were randomly divided into two groups: tracheal intubation or tracheotomy and mechanical ventilation. The protocol group conducted daily spontaneous respiratory function evaluation according to the procedure of the programmed weaning protocol, and patients who reached the evaluation standard were subjected to the 2-hour spontaneous breath test (SBT). Patients who successfully completed SBT will be evacuated from the ventilator. The control group evacuated the ventilator according to the conventional weaning method. Results The duration of mechanical ventilation (median 4 days) in the protocol group was shorter than that in the control group (median 6 days) (P = 0.032). Kaplan-Meier survival analysis and Cox proportional-hazards regression model showed that the protocol group was out of ventilator earlier than the control group (RR = 1.82, 95% CI 1.03-3.34, P = 0.041). No complications occurred during SBT. The incidence of complications in the protocol group during mechanical ventilation was lower than that in the control group (P <0.01). Conclusions The use of programmed weaning protocols in emergency care units can reduce the duration of mechanical ventilation and reduce the incidence of complications.