摘要
目的筛选缺血性卒中患者机械通气撤机成功的影响因素。方法采用前瞻性研究方法,对通过筛查试验和自主呼吸试验并满足撤机标准的30例急性缺血性卒中惠者,检测机械通气前及撤机前的格拉斯哥昏迷评分(Glasgow coma scale,GCS)、生命体征、生化指标以及浅快呼吸指数(rapid shallow breathing index,RSBI)和血气分析的变化。撤机后连续观察48h,需要重新应用呼吸机的定义为撤机失败,24h后可重复试验。无需应用呼吸机者定义为撤机成功。结果 30例患者共完成38次撤机,28次撤机成功,10次撤机失败,失败率26.3%。单因素分析结果表明:年龄,消化道出血、肺部感染、机械通气前和撤机前GCS评分的变化(△GCS)是影响撤机成功的危险因素(P<0.05)。机械通气前,与撤机失败组相比,撤机成功组的浅快呼吸指数偏低、动脉血二氧化碳分压(PaC0_2)高。撤机前,与撤机失败组相比,撤机成功组的GCS评分、血磷、白蛋白、氧合指数较高,而体温、收缩压、血糖和RSBI则显著降低,两组比较有统计学差异(P<0.05)。多因素分析结果表明:与撤机相关的独立因素为撤机前的RSBI、肺部感染和△GCS;3项指标判定能否撤机的敏感性为85.7%,特异性为70%,准确性为81.6%。结论撤机前的RSBI、肺部感染和△GCS为影响缺血性卒中患者机械通气撤机的独立因素。
Objective To evaluate the effects of predictors in the ventilator weaning process for patients with acute ischemic stroke.
Methods Thirty acute ischemic stroke patients fulfilled the criteria of discontinuing ventilation have been evaluated by the screening test and spontaneous breathing trial. The patients were continuously observed and successful weaning was defined if the patient did not need ventilation after 48 hours. Failed weaning was assured if the patients were ventilated again in 48h and were evaluated 24 hours after the first weaning. Glasgow Coma Scale, vital signs, traditional weaning predictors, rapid shallow breathing index（RSBI） and their dynamic changes were collected before ventilation and ventilator weaning.
Results Totally 38 weaning processes were carried out in 30 patients, with failed rate of 26.3%. Univariate analysis showed the average age, gastrointestinal hemorrhage, pulmonary infection, dynamic changes of GCS before and after ventilation were significantly associated with ventilation weaning in stroke patients（P〈0.05）. The successful group had lower RSBI and higher PaCO2 than the failed group before ventilation, and showed higher GCS, phosphorus, albumin, oxygen saturated index and lower temperature, dilated blood pressure, blood glucose and RSBI before weaning compared with the failed group. Logistic regression analysis showed RSBI, pulmonary infection and ΔGCS were the significant variables of weaning. By combining the three predictors, the sensitivity, specificity and accuracy were 85.7%, 70%, and 81.6% respectively.
Conclusion RSBI, pulmonary infection and ΔGCS are valuable and accurate predictors in the weaning process for patients with acute ischemic stroke.
出处
《中国卒中杂志》
2009年第12期956-960,共5页
Chinese Journal of Stroke
关键词
脑梗死
呼吸
人工
通气机
负压
Brain infarction Respiration artificial Ventilators negative-pressure
