摘要
目的观察老年重症颅脑损伤(sTBI)术后撤机困难患者采用有创-无创降级治疗闭环通气方案撤机的效果,探讨其安全性。方法2021年11月—2023年8月河南省人民医院sTBI术后有创机械通气撤机困难的老年患者57例,28例继续采用程序化方案撤机者为对照组,29例采用有创-无创降级治疗闭环通气方案撤机者为观察组。比较2组术后28d撤机成功率、成功撤机用时、术后28d呼吸机相关性肺炎和气管导管阻塞发生率;分别于观察组撤机前(T1)、撤机第7天(T2)测定2组膈肌移动度和氧合指数。结果观察组术后28d撤机成功率(51.7%)高于对照组(32.1%)(χ^(2)=4.140,P=0.036),成功撤机用时[(22.25±8.76)d]短于对照组[(26.20±8.05)d](t=3.214,P=0.028),术后28d呼吸机相关性肺炎发生率(13.8%)低于对照组(21.4%)(χ^(2)=2.342,P=0.042),气管导管阻塞率(3.4%)与对照组(3.6%)比较差异无统计学意义(χ^(2)=3.705,P=0.452)。观察组T1时膈肌移动度[(0.947±0.130)cm]、氧合指数(195.20±25.06)与对照组[(0.906±0.089)cm、206.12±22.24]比较差异均无统计学意义(t=0.683、0.851,P均>0.05)。观察组、对照组T2时膈肌移动度[(1.316±0.113)、(0.996±0.205)cm]均大于T1时(t=3.087、5.542,P均<0.05),氧合指数(217.07±32.17、223.31±29.79)与T1时比较差异均无统计学意义(t=1.299、1.308,P均>0.05)。观察组T2时膈肌移动度大于对照组(t=2.501,P=0.017),氧合指数与对照组比较差异无统计学意义(t=1.052,P=0.130)。结论老年sTBI术后撤机困难患者采用有创-无创降级治疗闭环通气方案撤机可保护膈肌功能,提高28d撤机成功率,减少呼吸机相关性肺炎发生。
Objective To observe the efficacy of a closed-loop ventilation weaning protocol with invasive-noninvasive step-down therapy in elderly patients with difficult weaning after severe traumatic brain injury(sTBI),and to explore its safety.Methods In 57 elderly patients with difficult weaning from invasive mechanical ventilation after sTBI in Henan Provincial People's Hospital from November 2021 to August 2023,28 patients continued to adopt the programmed weaning protocol(the control group),and 29 patients were weaned from the ventilator using the invasive-noninvasive step-down closed-loop ventilation protocol(the observation group).The success rate of weaning from the ventilator 28 d after surgery,time to successful weaning,and incidences of ventilator-associated pneumonia and tracheal catheter obstruction 28 d after surgery were compared between two groups.The diaphragmatic mobility and oxygenation index were measured before weaning(T1)and on the 7th day of weaning(T2)in the observation group.Results The observation group had a higher weaning success rate 28 d after surgery(51.7%),shorter time to successful weaning[(22.25±8.76)d],and lower incidence of ventilator-associated pneumonia 28 d after surgery(13.8%)compared with the control group[32.1%,(26.20±8.05)d,21.4%](χ^(2)=4.140,P=0.036;t=3.214,P=0.028;χ^(2)=2.342,P=0.042),while there was no statistically significant difference in the tracheal catheter obstruction rate between two groups(3.4%vs.3.6%)(χ^(2)=3.705,P=0.452).At T1,there were no statistically significant differences in diaphragmatic mobility and oxygenation index between the observation group[(0.947±0.130)cm,195.20±25.06]and the control group[(0.906±0.089)cm,206.12±22.24](t=0.683,0.213;both P values>0.05).The diaphragmatic mobilities in the observation and control groups were greater at T2[(1.316±0.113),(0.996±0.205)cm]than those at T1(t=3.087,5.542;both P values<0.05),and the oxygenation indixes in the observation group(217.07±32.17,223.31±29.79)showed no statistically significant differences compared with those at T1(t=1.299,1.308;both P values>0.05).At T2,the diaphragmatic mobility was greater in the observation group than that in the control group(t=2.501,P=0.017),and the oxygenation index showed no statistically significant difference between two groups(t=1.052,P=0.130).Conclusion For elderly patients with difficult weaning after sTBI,the adoption of closed-loop ventilation weaning with invasive-noninvasive step-down therapy can protect diaphragm function,increase the success rate of weaning within 28 d,and reduce the occurrence of ventilator-associated pneumonia.
作者
高胜浩
张婷
王海播
王学林
忽新刚
刘红梅
程剑剑
GAO Shenghao;ZHANG Ting;WANG Haibo;WANG Xuelin;HU Xingang;LIU Hongmei;CHENG Jianjian(Department of Respiratory and Critical Care Medicine,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2025年第9期813-817,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划项目(LHGJ20240091)。
关键词
重症颅脑损伤
有创机械通气
撤机困难
有创-无创降级治疗闭环通气方案
severe traumatic brain injury
mechanical ventilation
difficult weaning
closed-loop ventilation weaning with invasive-noninvasive step-down therapy
