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目的提高程序化撤机在重症监护室(ICU)内的应用水平,探讨程序化撤机模式。方法对水城矿业集团公司总医院ICU室2009年1月至2009年12月收治的142例机械通气患者的程序化撤机资料进行总结,142例患者中男99例,女43例,年龄8～77岁,平均(39±12)岁,呼吸支持时间2～696 h。呼吸机使用PB-760。SIMV模式时,下调机设频率至为5～6次/min,吸氧浓度下调至40%,行血气分析。PSV模式撤机时压力支持为7 cm H2O(1 cm Hg=0.098 kPa)以下行血气监测。对同步间歇指令通气(SIMV)+压力支持通气(PSV)模式患者,先渐降压力支持至7 cm H2O以下,再逐步降低机设呼吸频率至5～6次/min。血气分析结果如支持撤机,脱机自主通气20～30 min后拔管。结果 142例机械通气患者中一次脱机121例,脱机后再次上机21例。再次上机后成功脱机9例,死亡12例。结论程序化撤机可缩短带机时间,规范撤机行为。
Objective To improve the application of programmed weaning in intensive care unit (ICU) and to discuss the programmed weaning mode. Methods The procedural weaning information of 142 patients with mechanical ventilation received from January 2009 to December 2009 in ICU of General Hospital of Shuicheng Mining Group was summarized. Among 142 patients, 99 were male and 43 were female, with a mean age of 8 ~ 77 years old, with an average of (39 ± 12) years and respiratory support of 2 to 696 hours. Ventilator use PB-760. SIMV mode, down the machine set the frequency to 5 to 6 times / min, oxygen concentration decreased to 40%, blood gas analysis. The pressure support for PSV mode during weaning was 7 cm H2O (1 cm Hg = 0.098 kPa) for the following blood gas monitoring. For patients with synchronous intermittent mandatory ventilation (SIMV) and pressure support ventilation (PSV), the pressure should be gradually reduced to below 7 cm H2O before gradually reducing the ventilator frequency to 5-6 times / min. Blood gas analysis results such as supportive weaning, spontaneous ventilation after 20 ~ 30 min extubation. Results A total of 142 patients with mechanical ventilation were off-line in 121 cases and 21 cases were taken off-line again. After the success of the machine again offline in 9 cases, 12 patients died. Conclusion Procedural weaning can shorten the belt machine time, standard weaning behavior.