摘要
目的比较重症神经疾病机械通气患者应用程序化撤机方案和经验性撤机方案的临床效果。方法65例机械通气时间I〉24h的神经疾病患者根据随机数字表法随机分为两组，分别应用程序化撤机方案（32例）和经验性撤机方案（33例）。结果因5例患者放弃治疗脱漏，最后60例患者纳入分析，共有35例患者（58％）完成撤机。程序化撤机组（16例）的平均撤机时间（55．91h）明显短于经验性撤机组（19例，243．95h），两者差异有统计学意义（Z=-3．560，P〈0．01）。程序化撤机组的平均机械通气时间（程序化组272．01h，经验性组423．53h；t=-1．294，P=0．204），入住重症监护病房（ICU）的平均时间（程序化组611．03h，经验性组816．03h；t=-1．272，P=0．212），住ICU期间花费的总费用（程序化组101642．74元，经验性组130988．95元；t=-1．041，P=0．305）出现减少趋势，但差异无统计学意义。两组患者的撤机成功率、呼吸机相关性肺炎发病率、住院病死率相似，差异也无统计学意义。结论程序化撤机方案可有效缩短重症神经疾病患者的撤机时间，并使机械通气时间、住ICU时间和住ICU费用出现减少趋势。
Objective To compare protocol-directed weaning with traditional physician-directed weaning in neurocritical patients. Methods Sixty-five patients requiring mechanical ventilation for more than 24 hours were randomly assigned to receive either protocol-directed （ n = 32 ） or physician-directed （ n = 33 ） weaning. Results A total of 65 patients were enrolled in the study, of which 5 patients were excluded because of giving up treatment. Hence the data of 60 patients were subjected to availability analysis. Thirty-five patients were weaned from mechanical ventilation successfully. The mean weaning time was 55.91 hours for the protocol-directed group compared with 243.95 hours for the physician-directed group, which showed statistical difference （ Z = - 3. 560, P 〈 0. 01 ）. The mean duration of mechanical ventilation was shorter in the protocol-directed group （272. 01 hours） compared with that in the physician- directed group （423.53 hours, t = - 1. 294,P = 0. 204）. The weaning successful rate, ventilator-associated pneumonia incidence and intensive care unit （ICU） mortality rate of the two groups were similar, no statistical difference. The length of ICU stay was shorter in the protocol-directed group （611.03 hours） compared with that in the physician-directed group （816.03 hours, t = -1. 272, P = 0. 212）. ICU cost saving in the protocol-directed group was 29 346.21 yuan per patient compared with ICU cost in the physician-directed group （ 101 642. 74 yuan vs 130 988.95 yuan; t = - 1. 041, P = 0. 305 ）. Conclusion Protocol-directed weaning may be effective to reduce weaning time, duration of mechanical ventilation, length of ICU stay and ICU cost compared with physician-directed weaning in neurocritieal patients.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2013年第5期320-323,共4页
Chinese Journal of Neurology
关键词
神经系统疾病
呼吸
人工
通气机撤除法
临床方案
随机对照试验
Nervous system diseases
Respiration, artificial
Ventilator weaning
Clinicalprotocols
Randomized controlled trial
