摘要
目的:探究导致神经危重患者机械通气出现撤机困难及延迟撤机的影响因素和临床结果。方法:选取2019年12月~2020年10月入住弋矶山医院神经外科ICU行机械通气患者共100例。将患者分为简单撤机组、困难撤机组、延迟撤机组。记录3组患者的基础资料、相关临床资料、临床结果。结果:浅快呼吸指数(RSBI)增高(OR=1.036,95%CI:1.005~1.068)是困难及延迟撤机的危险因素(P<0.05),咳痰能力强(OR=0.247,95%CI:0.077~0.795)、肺部感染控制良好(OR=0.202,95%CI:0.063~0.650)、无呼吸系统基础病(OR=0.219,95%CI:0.051~0.935)是困难及延迟撤机的保护因素(P<0.05)。延迟撤机组的生存率和生存时间低于简单撤机组和困难撤机组(P<0.05),延迟撤机组与困难撤机组的气管切开率、ICU住院日、机械通气总时间均高于简单撤机组(P<0.05)。结论:在原发神经中枢疾病控制的基础上应积极训练患者的呼吸功能、提升患者的咳痰能力、有效控制肺部感染、积极治疗呼吸系统基础疾病可以尽量避免出现困难及延迟撤机。
Objective:To investigate the factors affecting weaning failure and delayed weaning from mechanical ventilation in critically ill patients.Methods:One hundred critically ill patients undergoing mechanical ventilation in the neurosurgery ICU of our hospital were included from December 2019 to October 2020,and divided into simple weaning group,difficult weaning group and prolonged weaning group.The basic information,relevant clinical data and clinical results were maintained in the three groups.Results:Increased RSBI(OR=1.036,95%CI:1.005-1.068)was a risk factor for weaning failure and delayed weaning(P<0.05),while strong sputum expectoration(OR=0.247,95%CI:0.077-0.795),better controlled lung infection(OR=0.202,95%CI:0.063-0.650)and free of underlying respiratory disease(OR=0.219,95%CI:0.051-0.935)were protective factors for difficult and prolonged weaning(P<0.05).The survival rate and survival time were significantly lower and shorter in the prolonged weaning group than in the simple and difficult weaning groups(P<0.05).Patients in the prolonged and difficult weaning groups had higher tracheotomy rate,longer ICU stay and total mechanical ventilation time than those in the simple weaning group(P<0.05).Conclusion:Weaning failure and prolonged weaning from mechanical ventilation can be improved in critically ill patients by control of the primary central nervous system diseases,active training of the patients′respiratory function,raising their sputum expectoration,effective control of the lung infection and aggressive treatment of the basic diseases of respiratory system.
作者
王奎
汤云
于涛
汪桂亮
范桢
窦云有
姜梦柯
WANG Kui;TANG Yun;YU Tao;WANG Guiliang;FAN Zhen;DOU Yunyou;JIANG Mengke(Intensive Care Unit of Neurosurgery,The First Affiliated Hospital of Wannan Medical College,Wuhu 241001,China)
出处
《皖南医学院学报》
CAS
2022年第1期96-100,共5页
Journal of Wannan Medical College
基金
安徽省重点研究和开发计划项目(201904a07020034)
安徽省卫生健康软科学研究项目(2020WR04009)。
关键词
神经危重患者
撤机
神经中枢
critically ill patients
weaning
nerve center
