脱机后剪短气管插管对慢性阻塞性肺疾病急性加重期患者脱机成功率的影响

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摘要目的探讨脱机后剪短气管插管对慢性阻塞性肺疾病急性加重期（AECOPD）患者脱机成功率的影响。方法回顾性分析2019年1～8月在我院重症医学科住院的行经口气管插管机械通气、血气分析均示Ⅱ型呼吸衰竭且已符合脱机标准的80例AECOPD患者作为实验组，选取2018年1～8月入住英德市人民医院ICU经口气管插管机械通气、血气分析均示Ⅱ型呼吸衰竭且已符合脱机标准的80例AECOPD患者作为对照组。两组患者均给予常规药物治疗，并经口气管插管行有创机械通气。当患者达到脱机标准后，对照组按照常规操作进行SBT，试验组将气管插管接头拔除及气管导管外露长度剪短至显影线25cm处后进行SBT。比较两组患者在脱机拔管后的呼吸频率、心率、浅快呼吸指数、氧合指数、脉搏血氧饱和度、潮气量、口腔闭合压、肺动态顺应性等指标以及脱机成功率。结果实验组患者的呼吸频率、心率和浅快呼吸指数均低于对照组，差异有统计学意义（P＜0.05）。实验组患者的氧合指数、脉搏血氧饱和度、潮气量、口腔闭合压、肺动态顺应性均高于对照组，差异有统计学意义（P＜0.05）。实验组的SBT成功率为93.75%，高于对照组的73.75%（P＜0.05）；实验组的再插管率为3.75%，低于对照组的10.00%（P＜0.05）；实验组的脱机成功率为90.00%，高于对照组的63.75%，差异有统计学意义（P＜0.05）。结论气管插管被剪短后提高了AECOPD患者通过SBT试验及脱机、拔管成功率，降低了患者的ICU住院日及住院费用，疗效明显，能够产生社会效益和经济效益。

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	曾佑强
	文秋红

关键词 ：慢性阻塞性肺疾病, 机械通气, 剪短气管, 脱机成功

Abstract：Objective To investigate the influence of short-cut endotracheal intubation on the offline success rate of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Retrospective analysis of 80 patients with AECOPD who had undergone oral and tracheal intubation mechanical ventilation and blood gas analysis in the department of critical caremedicine from January 2019 to August 2019 in our hospitalwere selected as the experimental group.From January to August 2018,the 80 patients with AEDPD who underwentmechanical ventilation and blood gas analysis of the intubation in the ICU were shown to have typeⅡrespiratory failure and who had met the criteria for weaning were selected as the control group.Both groups of patients were given conventionalmedical treatment,and invasive mechanical ventilation was performed through oral intubation.When the patients reached the offline standard,the control group underwent SBT according to the routine operation.The experimental group removed the tracheal intubation connector and shortened the length of the tracheal tube to 25cm after the development line,and then performed SBT.The indexes of respiratory rate,heart rate,shallow respiratory index,oxygenation index,pulse oximetry,tidal volume,oral closure pressure,and lung dynamic compliance after the extubation and offline success rate were compared between the two groups.Results The respiratory rate,heart rate and shallow respiratory index of the experimental group were lower than those of the control group,and the differences were statistically significant(P＜0.05).The oxygenation index,pulse oximetry,tidal volume,and oral closure pressure,the lung dynamic compliance in the experimental group were higher than those in the control group,and the differences were statistically significant(P＜0.05).The success rate of SBT in the experimental group was 93.75%,which was higher than that in the control group (73.75%)(P＜0.05).The intubation rate of the experimental group was 3.75%,which was lower than that of the control group(10.00%)(P＜0.05).The offline success rate in the experimental group was 90.00%,which was higher than that of the control group (63.75%),and the difference was statistically significant(P＜0.05).Conclusion When the endotracheal tube is cut short,the success rate of passing SBT test,weaning and extubation of AECOPD patients is increased,the length of stay in ICU and the cost of hospitalization is reduced,the curative effect is obvious,and social and economic benefits can be produced.

Key words： Chronic obstructive pulmonary disease Mechanical ventilation Short-cut trachea Successful offline

基金资助:广东省英德市人民医院计划项目

作者简介: 曾佑强（1986-），男，汉族，广东英德人，本科，内科学主治医师，研究方向：临床医学

引用本文:

曾佑强；文秋红. 脱机后剪短气管插管对慢性阻塞性肺疾病急性加重期患者脱机成功率的影响[J]. 中国当代医药, 2020, 27(17): 69-72.
ZENG You-qiang； WEN Qiu-hong. Influence of short-cut endotracheal intubation on off-line success rate in patients with acute exacerbation of chronic obstructive pulmonary disease. 中国当代医药, 2020, 27(17): 69-72.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2020/V27/I17/69

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