本文選題：肺部超聲 + 機(jī)械通氣�。� 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的對(duì)于ICU中接受氣管插管有創(chuàng)機(jī)械通氣治療超過48小時(shí),評(píng)估脫機(jī)可能性后成功通過自主呼吸試驗(yàn)(Spntaneous Breathing Trial,SBT)的患者,應(yīng)用肺部超聲評(píng)估聯(lián)合高流量鼻導(dǎo)管氧療技術(shù)(High Flow Nasal Canual Oxygen,HFNCO)與無創(chuàng)機(jī)械通氣(Non-invasive Mechanical Ventilation,NIV),降低拔管后48小時(shí)內(nèi)拔管失敗率、再插管率及相關(guān)并發(fā)癥的發(fā)生率。方法選取昆明醫(yī)科大學(xué)第一附屬醫(yī)院2014年9月1日-2017年3月1日收住EICU的89例進(jìn)行氣管插管有創(chuàng)機(jī)械通氣治療的患者,每日評(píng)估脫機(jī)可能性后行SBT,對(duì)于成功通過SBT并決定拔管的患者,拔管前進(jìn)行肺部超聲評(píng)估。納入肺部超聲評(píng)分≥15分的患者并隨機(jī)分為A組、B組、C組和D組,基于診治原發(fā)病、抗感染、營(yíng)養(yǎng)支持等治療的基礎(chǔ)上,A組拔管后序貫使用傳統(tǒng)氧療模式,B組拔管后48小時(shí)內(nèi)使用NIV呼吸模式,C組拔管后48小時(shí)內(nèi)使用HFNCO呼吸模式,D組拔管后48小時(shí)內(nèi)交替使用HFNCO呼吸模式+NIV呼吸模式,比較四組患者拔管后氧療效果及轉(zhuǎn)歸。結(jié)果1.四組患者在基線指標(biāo)方面無統(tǒng)計(jì)學(xué)差異(P0.05)。2.B、C、D三組在拔管后lh、6h、12h、24h、48h經(jīng)皮指脈氧飽和度、動(dòng)脈血氧分壓數(shù)值均高于A組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。呼吸頻率、動(dòng)脈血二氧化碳分壓數(shù)值B、C、D三組均低于A組,其中C組顯示出更好的CO2清除作用,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.B、C、D三組拔管后48小時(shí)內(nèi)拔管失敗率、再插管率低于A組,其中D組患者預(yù)后最佳;拔管后28天內(nèi)機(jī)械通氣時(shí)間、抗生素使用時(shí)間及入住ICU時(shí)間B、C、D三組均低于A組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.根據(jù)數(shù)字化評(píng)分C組患者舒適度及氣體濕化程度明顯優(yōu)于其余三組,差異有統(tǒng)計(jì)學(xué)(P0.05)。結(jié)論1.對(duì)于具有拔管失敗高風(fēng)險(xiǎn)的患者,拔管后序貫使用HFNCO+NIV能有效降低拔管失敗率與再插管率;縮短機(jī)械通氣時(shí)間、抗生素使用時(shí)間及拔管后入住ICU時(shí)間,減少呼吸機(jī)相關(guān)性肺炎的發(fā)生率,充分改善患者預(yù)后。2.拔管后單獨(dú)使用HFNCO或NIV均能降低拔管失敗率及再插管率,兩組間差異無統(tǒng)計(jì)學(xué)意義,但HFNCO的氣體濕化程度、舒適度、患者耐受性均優(yōu)于NIV。3.床旁肺部超聲對(duì)機(jī)械通氣患者拔管成功率的判斷具有臨床應(yīng)有價(jià)值,可以指導(dǎo)撤機(jī)、拔管。
[Abstract]:Objective to evaluate the possibility of weaning in ICU patients who received tracheal intubation and mechanical ventilation for more than 48 hours. Lung ultrasound was used to evaluate the combination of high Flow Nasal Canual oxygenation (HFNCO) and non-invasive Mechanical ventilation (NIV) in order to reduce the failure rate of extubation, the rate of re-intubation and the incidence of related complications within 48 hours after extubation. Methods 89 patients who received EICU from September 1, 2014 to March 1, 2017 in the first affiliated Hospital of Kunming Medical University were treated with tracheal intubation and mechanical ventilation. SBT was performed after daily evaluation of the possibility of weaning, and pulmonary ultrasound was performed before extubation for patients who successfully passed SBT and decided to extubation. The patients with pulmonary ultrasound score 鈮，

本文編號(hào)：1813013