自主呼吸试验在早产儿拔管撤机中的应用价值

doi:10.12372/jcp.2022.21e1563

摘要/Abstract

摘要：

目的探讨自主呼吸试验（SBT）在需有创机械通气的早产儿拔管撤机过程中的临床应用价值。方法需有创机械通气治疗的117例早产儿随机分为两组,SBT组（n=57）采用SBT指导撤机,临床判断组（n=60）根据临床经验指导撤机,比较两组患儿撤机后72小时内再插管率（撤机失败率）、机械通气时间及住院时间。结果 117例患儿中,男60例、女57例,中位出生胎龄27.7（26.3~30.1）周,中位出生体重1 000.0（825.0~1 300.0）g。SBT组57例患儿共进行了113次SBT。SBT组撤机失败率低于临床判断组,差异有统计学意义（P<0.05）。两组之间机械通气时间和住院时间差异均无统计学意义（P>0.05）。结论 SBT可有效降低早产儿拔管撤机失败率,而不增加机械通气时间,或可用来预测早产儿成功拔管。

关键词: 自主呼吸试验, 早产儿, 机械通气, 拔管

Abstract:

Objective To investigate the clinical application value of spontaneous breathing trial (SBT) in the extubation of premature infants requiring invasive mechanical ventilation. Methods A total of 117 preterm infants requiring invasive mechanical ventilation were randomly divided into two groups. The children in SBT group (n=57) were extubated after SBT, and the children in clinical judgment group (n=60) were extubated based on the clinical experience. The reintubation rate within 72 hours after weaning (failure rate of weaning), mechanical ventilation duration and total hospital stay were compared between the two groups. Results The median gestational age and birth weight of 117 children (60 boys and 57 girls) were 27.7 (26.3-30.1) weeks and 1000.0 (825.0-1300.0) g. In SBT group, 57 children underwent 113 SBT. The failure rate of weaning in the SBT group was significantly lower than that in the clinical judgment group (P<0.05). There were no significant differences in mechanical ventilation duration and total hospital stay between the two groups (P>0.05). Conclusions SBT can effectively reduce the failure rate of extubation in preterm infants without increasing the duration of mechanical ventilation, and it may be used to predict successful extubation in preterm infants.

Key words: spontaneous breathing trial, premature infant, mechanical ventilation, extubation

李哲, 朱晓波, 薛江. 自主呼吸试验在早产儿拔管撤机中的应用价值[J]. 临床儿科杂志, 2022, 40(10): 755-759.

LI Zhe, ZHU Xiaobo, XUE Jiang. Application value of spontaneous breathing trial in the extubation of premature infants[J]. Journal of Clinical Pediatrics, 2022, 40(10): 755-759.

图/表 1

参考文献 23

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项目	SBT组(n=57)	临床判断组(n=60)	统计量	P
出生胎龄[M(P₂₅~P₇₅)]/周	27.9(26.3~30.1)	27.7(26.3~30.3)	Z=0.11	0.913
出生体重[M(P₂₅~P₇₅)]/g	990.0(830.0~1 275.0)	1 035.0(823.0~1 038.0)	Z=0.32	0.750
性别(男/女, n)	29/28	31/29	χ²=0.01	0.932
分娩方式为剖宫产[n(%)]	27(47.4)	27(45.0)	χ²=0.07	0.797
产前类固醇激素使用[n(%)]	38(66.7)	42(70.0)	χ²=0.15	0.698
1分钟Apgar评分[M(P₂₅~P₇₅)]/分	9.0(8.0~9.0)	8.5(7.3~9.0)	Z=0.68	0.494
5分钟Apgar评分[M(P₂₅~P₇₅)]/分	10.0(9.0~10.0)	10.0(9.0~10.0)	Z=0.80	0.425
机械通气时间[M(P₂₅~P₇₅)]/h	50.0(34.0~122.0)	57.5(38.3~129.3)	Z=0.72	0.470
住院时间[M(P₂₅~P₇₅)]/d	56.0(39.0~71.0)	55.5(39.3~75.8)	Z=0.42	0.672
拔管撤机失败[n(%)]	2(3.5)	9(15.0)	χ²=4.53	0.033