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[机械通气撤机的重要步骤:呼吸肌力量的准确评估]

[Important step of weaning from mechanical ventilation: accurate assessment of respiratory muscle strength].

作者信息

Qin Yingzhi, Gao Xinjing

机构信息

Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin 300170, China. Corresponding author: Gao Xinjing, Email:

出版信息

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Apr;36(4):337-339. doi: 10.3760/cma.j.cn121430-20231120-00991.

DOI:10.3760/cma.j.cn121430-20231120-00991
PMID:38813624
Abstract

Mechanical ventilation (MV) is a powerful mean to rescue patients with respiratory failure. In view of the different etiology and basic respiratory function of patients with respiratory failure, weaning failure often occurs. Prolonged MV time is often accompanied by many complications. Thus, deeply understanding the pathophysiological changes of respiratory failure and strengthen monitoring of respiratory mechanics are helpful to optimize MV parameter settings, reduce ventilator-induced lung injury and wean from MV as early as possible. A successful weaning from MV depends on many factors, the most important factors are respiratory muscle strength, respiratory load and respiratory drive. Spontaneous breathing trial (SBT) is an important part of weaning process. The main purpose of implementing SBT is to screen patients and opportunities to weaning from MV, and find reversible reasons for not passing SBT. Because the accuracy of SBT in assessing weaning prognosis is about 85%, it is not adequate for difficult weaning patients. Standardized measurement of weaning indicators for patients with difficulty weaning is conducive to accurate assessment of respiratory muscle strength and improve the success rate of weaning from MV.

摘要

机械通气(MV)是抢救呼吸衰竭患者的有力手段。鉴于呼吸衰竭患者病因及基础呼吸功能各异,撤机失败常发生。MV时间延长常伴有诸多并发症。因此,深入了解呼吸衰竭的病理生理变化并加强呼吸力学监测,有助于优化MV参数设置,减少呼吸机相关性肺损伤并尽早撤机。成功撤机取决于诸多因素,其中最重要的因素是呼吸肌力量、呼吸负荷和呼吸驱动。自主呼吸试验(SBT)是撤机过程的重要组成部分。实施SBT的主要目的是筛选撤机患者及撤机时机,并找出未通过SBT的可逆原因。由于SBT评估撤机预后的准确性约为85%,对于撤机困难的患者而言并不足够。对撤机困难患者的撤机指标进行标准化测量,有利于准确评估呼吸肌力量并提高撤机成功率。

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