论文部分内容阅读
目的研究呼吸衰竭患者集束化措施的执行率以及与机械通气时间的相关性。方法回顾性分析中国医学科学院肿瘤医院重症医学科(ICU)2013年6月至2014年12月间收治的全部危重患者,纳入机械通气时间>2 d的重症呼吸衰竭患者。结果最终纳入分析的病例为55例,男43例,女12例,年龄(63.47±12.49)岁。转入时序贯器官衰竭评分(SOFA)为2.8±2.2,转入时简化急性生理学评分3(SAPS3)为51±14。55例患者的平均机械通气时间为(7.3±5.5)d。小潮气量策略的执行率为23.6%(13/55)。符合小潮气量策略的13例患者机械通气时间为(7.31±7.02)d,而不符合小潮气量策略的42例患者的机械通气时间为(7.31±5.07)d,两组之间差异无统计学意义(P=0.444)。相关分析发现:程序化镇静策略的执行率与机械通气时间呈明显负相关(r2=0.312,P<0.001);每日唤醒策略的执行率与机械通气时间呈明显负相关(r2=0.337,P<0.001);每日自主呼吸试验策略的执行率与机械通气时间呈明显负相关(r2=0.280,P<0.001)。多重线性回归分析发现仅每日唤醒策略与机械通气时间显著相关(B=-0.623,P<0.001),而程序化诊断和每日自主呼吸试验策略没有显著相关性。结论呼吸衰竭患者的集束化措施尤其是每日唤醒策略的执行率越高,机械通气时间越短。
Objective To study the implementation rate of clustering measures in patients with respiratory failure and the correlation with mechanical ventilation time. Methods All critically ill patients admitted to ICU of Chinese Academy of Medical Sciences from June 2013 to December 2014 were retrospectively analyzed. Patients with severe respiratory failure with mechanical ventilation> 2 days were enrolled. Results The final analysis included 55 cases, 43 males and 12 females, with an age of (63.47 ± 12.49) years. The mean sequential organ failure score (SOFA) at entry was 2.8 ± 2.2, and SAPS3 at entry was 51 ± 14.55. The mean duration of mechanical ventilation was (7.3 ± 5.5) days. The implementation rate of a small tidal volume strategy was 23.6% (13/55). The duration of mechanical ventilation was (7.31 ± 7.02) days in 13 patients who met the low tidal volume strategy and the duration of mechanical ventilation was (7.31 ± 5.07) days in 42 patients who did not meet the low tidal volume strategy. There was no significant difference between the two groups (P = 0.444). Correlation analysis showed that the execution rate of procedural sedation was negatively correlated with the duration of mechanical ventilation (r2 = 0.312, P <0.001). The daily awakening strategy was negatively correlated with the duration of mechanical ventilation (r2 = 0.337, P <0.001). The rate of daily spontaneous breathing test was negatively correlated with the duration of mechanical ventilation (r2 = 0.280, P <0.001). Multiple linear regression analysis found that daily wake-up strategy was significantly associated with mechanical ventilation time (B = -0.623, P <0.001), while there was no significant correlation between programmed diagnosis and daily spontaneous breathing test strategy. Conclusions The higher the rate of implementation of bundling measures, especially the daily wake-up strategy, in patients with respiratory failure, the shorter the duration of mechanical ventilation.