呼吸系统功能评分在慢性阻塞性肺疾病并呼吸衰竭患者呼吸机撤机中的应用价值

摘要

目的 分析呼吸系统功能评分在慢性阻塞性肺疾病(COPD)并呼吸衰竭患者呼吸机撤机中的应用价值.方法 选取2014年3月-2016年3月海南省琼海市人民医院收治的COPD并呼吸衰竭患者60例,均行气管插管及机械通气治疗,采用随机数字表法分为A组、B组和C组,每组20例.A组患者采用传统撤机方法,B组患者在呼吸系统功能评分为3~4分时撤机,C组患者在呼吸系统功能评分为5~6分时撤机.比较3组患者撤机情况(包括直接撤机成功、无创通气辅助困难撤机、再次气管插管及总撤机成功)、机械通气时间、入住ICU时间及并发症发生率.结果 3组患者无创通气辅助困难撤概率、再次气管插管率及总撤机成功率比较,差异无统计学意义(P>0.05);A组和B组患者直接撤机成功率高于C组(P<0.05),而A组与B组患者直接撤机成功率比较,差异无统计学意义(P>0.05).B组和C组患者机械通气时间、入住ICU时间均短于A组(P<0.05),而B组与C组患者机械通气时间、住ICU时间比较,差异无统计学意义(P>0.05).3组患者胃肠道反应发生率比较,差异无统计学意义(P>0.05);B组和C组患者肺部气压伤、呼吸机相关性肺炎(VAP)发生率低于A组(P<0.05),而B组与C组患者肺部气压伤、VAP发生率比较,差异无统计学意义(P>0.05).结论 将呼吸系统功能评分3~4分作为呼吸机撤机指标可有效缩短COPD并呼吸衰竭患者机械通气时间和入住ICU时间,降低肺部气压伤和VAP发生率,且不影响撤机成功率.%Objective To analyze the application effect of respiratory system function score on ventilator weaning in COPD patients complicated with respiratory failure.Methods A total of 60 COPD patients complicated with respiratory failure were selected in the People′s Hospital of Qionghai from March 2014 to March 2016,all of them received endotracheal intubation and mechanical ventilation,and they were divided into A group,B group and C group according to random number table,each of 20 cases.Patients of A group received ventilator weaning according to traditional method,patients of B group received ventilator weaning when respiratory system function score was 3 to 4,while patients of B group received ventilator weaning when respiratory system function score was 5 to 6.Ventilator weaning results(including directly successful ventilator weaning,non-invasive ventilation for difficult ventilator weaning,re-endotracheal intubation and total successful ventilator weaning),duration of mechanical ventilation,ICU stays and incidence of complications were compared among the three groups.Results No statistically significant differences of using rate of non-invasive ventilation for difficult ventilator weaning,re-endotracheal intubation rate or total successful ventilator weaning rate was found among the three groups(P>0.05);directly successful ventilator weaning rate of A group and B group was statistically significantly higher than that of C group,respectively(P<0.05),while no statistically significant differences of directly successful ventilator weaning rate was found between A group and B group(P>0.05).Duration of mechanical ventilation and ICU stays of B group and C group were statistically significantly shorter than those of A group(P<0.05),while no statistically significant differences of duration of mechanical ventilation or ICU stays was found between B group and C group(P>0.05).No statistically significant differences of incidence of gastrointestinal reaction was found among the three groups(P>0.05);incidence of lung barotraumas and VAP of B group and C group was statistically significantly lower than that of A group,respectively(P<0.05),while no statistically significant differences of incidence of lung barotraumas or VAP was found between the B group and C group(P>0.05).Conclusion Ventilator weaning when respiratory system function score is 3 to 4 can effectively shorten the duration of mechanical ventilation or ICU stays,reduce the incidence of lung barotraumas and VAP in COPD patients complicated with respiratory failure,without obvious affect on successful ventilator weaning rate.