预防性应用无创机械通气降低咳嗽能力差患者拔管失败的有效性研究

发布时间：2018-05-26 07:48

本文选题：气管插管 + 自主呼吸撤机试验　；参考：《重庆医科大学学报》2017年01期

【摘要】：目的:探讨咳嗽能力差的患者拔管后预防性应用无创机械通气降低拔管失败的有效性。方法:选择2011至2015年入住我科监护室通过自主呼吸撤机试验准备拔管且咳嗽能力差的106例患者为研究对象。咳嗽能力差定义为患者拔管时半定量咳嗽能力评估小于等于2级。拔管后57例患者预防性使用无创机械通气以减少拔管后呼吸功能衰竭的发生(试验组),另有49例患者仅接受常规的鼻导管吸氧(对照组)。主要观察结局指标为拔管后72 h再插管率。结果:预防性应用无创通气显著降低患者拔管后72 h再插管率(12%vs.39%,P=0.003)。多变量逻辑回归分析发现,预防性应用无创通气是拔管后72 h再插管的保护因子(风险比OR=0.22,95%CI=0.08~0.59,P=0.002)。在存活的患者中,预防性应用无创通气显著缩短了患者住重症监护室时间(13 d vs.21 d,P=0.04)。结论:咳嗽能力差的患者通过自主呼吸撤机试验拔管后,预防性应用无创通气可以降低患者的再插管率。
[Abstract]:Objective: to investigate the effectiveness of prophylactic application of non-invasive mechanical ventilation after extubation in patients with poor cough ability to reduce the failure of extubation. Methods: 106 patients who were admitted to our unit from 2011 to 2015 to prepare for extubation and had poor cough ability were selected as subjects. Poor cough ability is defined as the semi-quantitative cough ability assessment of patients with extubation less than or equal to grade 2. After extubation, 57 patients were given preventive non-invasive mechanical ventilation to reduce the incidence of respiratory failure after extubation (experimental group, 49 patients received only routine nasal catheter oxygen inhalation (control group). The main outcome index was the rate of intubation 72 hours after extubation. Results: prophylactic application of noninvasive ventilation significantly decreased the rate of re-intubation 72 hours after extubation. Multivariate logistic regression analysis showed that prophylactic application of noninvasive ventilation was a protective factor for intubation 72 hours after extubation (the risk ratio was 0.2295 CI 0.08 0. 59p 0. 002). In surviving patients, prophylactic use of noninvasive ventilation significantly shortened the duration of stay in intensive care unit (ICU) for 13 days (vs.21 dP0. 04). Conclusion: noninvasive ventilation can reduce the rate of reintubation after extubation in patients with poor cough ability.
【作者单位】：重庆医科大学附属第一医院呼吸内科;
【分类号】：R459.7

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