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中华重症医学电子杂志 ›› 2023, Vol. 09 ›› Issue (01) : 54 -61. doi: 10.3877/cma.j.issn.2096-1537.2023.01.010

临床研究

T管与PSV自主呼吸试验对重症患者成功撤机后临床转归的影响——一项回顾性队列研究
朱秀芬1, 韦碧琳1, 郑慧芳1, 丁林芳1, 徐子萌1, 余文轩1, 原皓1, 常泽楠1, 黄志坤1, 刘紫锰1,()   
  1. 1. 510080 广州,中山大学附属第一医院重症医学科
  • 收稿日期:2023-02-03 出版日期:2023-02-28
  • 通信作者: 刘紫锰

Effects of T-piece and PSV spontaneous breathing trials on clinical outcomes after successful weaning in critically ill patients: a retrospective cohort study

Xiufen Zhu1, Biling Wei1, Huifang Zheng1, Linfang Ding1, Zimeng Xu1, Wenxuan Yu1, Hao Yuan1, Zhenan Chang1, Zhikun Huang1, Zimeng Liu1,()   

  1. 1. Department of Surgical Intensive Care Unit, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2023-02-03 Published:2023-02-28
  • Corresponding author: Zimeng Liu
引用本文:

朱秀芬, 韦碧琳, 郑慧芳, 丁林芳, 徐子萌, 余文轩, 原皓, 常泽楠, 黄志坤, 刘紫锰. T管与PSV自主呼吸试验对重症患者成功撤机后临床转归的影响——一项回顾性队列研究[J/OL]. 中华重症医学电子杂志, 2023, 09(01): 54-61.

Xiufen Zhu, Biling Wei, Huifang Zheng, Linfang Ding, Zimeng Xu, Wenxuan Yu, Hao Yuan, Zhenan Chang, Zhikun Huang, Zimeng Liu. Effects of T-piece and PSV spontaneous breathing trials on clinical outcomes after successful weaning in critically ill patients: a retrospective cohort study[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(01): 54-61.

目的

比较低水平压力辅助通气(PSV)与T管进行自主呼吸试验(SBT)对机械通气患者成功撤机后临床转归的影响。

方法

回顾性分析2019年1月至2020年12月中山大学附属第一医院重症一科收治的253例机械通气时间在24 h至2周内的重症患者。所有患者均成功通过SBT并拔除气管插管,根据拔管前SBT方法分为PSV组和T管组。比较2组拔管后呼吸衰竭发生率、呼吸衰竭发生时间、呼吸衰竭发生原因、再插管率、拔管时间、拔管后ICU停留时间、机械通气时间、ICU住院时间、入ICU后至拔管前时间、在院时间、在院全因病死率等临床转归的差异。

结果

2组在呼吸衰竭发生率、呼吸衰竭发生时间、再插管率、住院病死率、在院时间上比较,差异均无统计学意义(P>0.05)。与T管组相比,PSV组从开始SBT至拔除气管导管时间明显更短,机械通气时间[2.9(1.7,4.8)d vs 3.9(1.8,6.3)d]及ICU住院时间均更短[6.2(3.9,10.8)d vs 8.8(4.5,12.5)],差异均有统计学意义(P<0.05)。

结论

机械通气患者撤机时SBT采用PSV法更有利于加快撤机进程,减少机械通气时间并缩短ICU住院时间,不增加拔管后呼吸衰竭发生率。

Objective

To evaluate the effects of spontaneous breathing trials (SBT) between T-piece and low-level pressure-assisted ventilation (PSV) on clinical outcomes after successful weaning in mechanically ventilated patients.

Methods

This retrospective cohort study was performed for 253 critically ill patients with a mechanical ventilation duration of 24 hours to 2 weeks admitted to the Department of Surgical Intensive Care of the First Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2020. All patients successfully passed SBT and removed the endotracheal intubation, and were divided into PSV group and T-piece group according to the SBT method before extubation. The differences in clinical outcomes such as the incidence of respiratory failure, time of occurrence of respiratory failure, causes of respiratory failure, reintubation rate, time to extubation, duration of ICU stay after extubation, duration of mechanical ventilation, length of stay in ICU, time after admission to extubation, time in hospital, and all-cause mortality rate in hospital were compared between the two groups.

Results

There were no significant differences in the incidence of respiratory failure, time to occurrence of respiratory failure, reintubation rate, inpatient mortality, and length of hospitalization between the two groups (P>0.05). Compared with the T-piece group, the time from initiation of SBT to removal of the endotracheal tube was significantly shortened in the PSV group, and the duration of mechanical ventilation [2.9 (1.7, 4.8 d) d vs 3.9 (1.8, 6.3) d] and ICU length of stay were shorter [6.2 (3.9, 10.8) d vs 8.8 (4.5, 12.5) d] (P<0.05).

Conclusion

The low PEEP PSV method used by SBT for mechanical ventilation weaning is more conducive to acceleration the weaning process, reduces mechanical ventilation time, and shortens ICU stay.

图1 研究对象筛选流程注:SBT为自主呼吸试验;PSV为压力支持通气
表1 2组机械通气患者一般资料比较
表2 2组机械通气患者基线合并症比较[例(%)]
表3 2组机械通气患者不同时间点生命体征、血气等指标比较(
xˉ
±s
表4 2组机械通气患者主要结局指标比较[例(%)]
表5 2组机械通气患者次要结局指标比较
次要结局指标 总体情况(253例) T管组(97例) PSV组(156例) 统计值 P
拔管后ICU停留时间[d,M(P25,P75 2.9(1.3,5.3) 3.0(1.8,6.1) 2.8(1.2,5.1) Z=1.633 0.229
入ICU至拔管前时间[d,M(P25,P75 3.5(1.8,5.8) 4.2(2.0,7.5) 3.3(1.7,5.5) Z=2.374 0.039
机械通气时间[d,M(P25,P75 3.1(1.7,5.3) 3.9(1.8,6.3) 2.9(1.7,4.8) Z=1.937 0.048
ICU住院时间[d,M(P25,P75 7.0(4.1,11.7) 8.8(4.5,12.5) 6.2(3.9,10.8) Z=2.394 0.044
在院时间[d,M(P25,P75 24.8(15.8,38.8) 25.4(16.6,41.8) 24.7(15.2,37.3) Z=0.776 0.497
出ICU后在院时间[d,M(P25,P75 8.8(4.0,18.8) 8.9(4.0,19.0) 8.8(4.0,18.7) Z=0.047 0.867
SBT开始至拔管时间(h,
x¯
±s
124.2±108.3 174.5±127.6 92±80 t=6.253 <0.001
SBT开始至拔管时间[例(%)]
<60 min 119(47.0) 19(19.6) 100(64.1) χ2=45.574 <0.001
60~120 min 64(25.4) 33(34.0) 31(19.9) χ2=5.609 0.012
>120 min 69(27.3) 44(45.4) 25(16.0) χ2=25.949 <0.001
ICU转归[例(%)]
达转出ICU标准转出 224(88.5) 82(84.5) 142(91.0) χ2=2.482 0.115
家属要求出ICU但明显好转 15(5.9) 9(9.3) 6(3.8) χ2=3.164 0.075
家属放弃出ICU 7(2.8) 3(3.1) 4(2.6) χ2=0.021 1.000
死亡 7(2.8) 3(3.1) 4(2.6) χ2=0.021 1.000
临床转归[例(%)]
好转出院 178(70.4) 65(67) 113(72.4) χ2=0.844 0.358
好转转院 42(16.6) 21(21.6) 21(13.5) χ2=2.896 0.089
家属放弃出院 19(7.5) 5(5.2) 14(9.0) χ2=0.766 0.262
死亡 14(5.5) 6(6.2) 8(5.1) χ2=0.128 0.721
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