作者:郭永生1,刘凯2
单位:1. 复旦大学附属中山医院梅陇院区(上海市老年医学中心);2. 复旦大学附属中山医院重症医学科
困难撤机(difficult weaning)是指对进行机械通气的患者评估能否撤机时,需要进行3次自主呼吸试验(spontaneous breathing trial,SBT),或从第一次SBT起需要长达7 d才能成功撤机。临床中有20%~30%的机械通气患者难以脱离有创机械通气,困难撤机会使患者机械通气的时间明显延长,长期机械通气与患者发生呼吸机相关性肺炎和ICU患者住院死亡率相关。因此,及早对机械通气患者进行困难撤机的筛查与预测,早期识别可能导致困难撤机的危险因素并及时纠正,能够明显改善患者的预后。
导致患者困难撤机或撤机失败的原因可以大致概括为“ABCDE”五个方向:气道和肺功能障碍(Airway/lung),脑功能障碍(Brain),心功能障碍(Cardiac),膈肌功能障碍(Diaphragm)和内分泌功能障碍(Endocrine),除此之外还有一些其他因素,例如心理依赖及某些全身性的疾病等也会导致患者撤机困难。临床医生和呼吸治疗师在患者撤机前应进行全面的评估,避免困难撤机的发生。本文综述困难撤机的原因,以期为临床提供参考。
Airway and lung dysfunction:气道和肺功能障碍
Brain dysfunction:大脑和精神状态
Cardiac dysfunction:心脏功能障碍
Diaphragm/respiratory muscle function:膈肌/呼吸肌功能
Endocrine and metabolic dysfunction:内分泌及代谢功能障碍
参考文献
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作者简介
郭永生
复旦大学附属中山医院梅陇院区(上海市老年医学中心)呼吸治疗师
上海呼吸治疗联盟成员
毕业于四川大学华西临床医学院呼吸治疗专业
刘凯
复旦大学附属中山医院重症医学科主管呼吸治疗师
中国康复医学会重症康复专委会重症生命支持学组委员
中国医药教育协会重症康复专业委员会委员
中国医药教育协会超声委员会重症超声学组委员
呼吸治疗师国家职业技能标准开发专家委员会委员
上海市中西医结合学会呼吸技术诊疗专委会青年委员
中华医学会重症医学分会ECMO/纤支镜/超声师资班培训讲师
中国重症超声研究组(CCUSG)培训讲师
以第一/共一作者发表SCI 10篇、中文核心1篇、院内课题2项
参编专家共识3部、行业规范和标准3部、专业著作11部
已获实用专利11项、外观专利1项,正在申请专利8项
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