摘要
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。
Abstract
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.
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