對(duì)意外或自主拔管患者的研究顯示，接受完全機(jī)械通氣患者的23％和開(kāi)始撤機(jī)過(guò)程患者的69％并不需要重新插管，這表明機(jī)械通氣患者的撤機(jī)存在被延遲的傾向，致使患者承受不必要的痛苦，增加了并發(fā)癥的發(fā)生率和醫(yī)療費(fèi)用。撤機(jī)過(guò)程所耗費(fèi)的時(shí)間占機(jī)械通氣整個(gè)時(shí)間的40％~50％ 。Esteban等的研究證明：延長(zhǎng)通氣時(shí)間增加病死率。在美國(guó)，機(jī)械通氣的費(fèi)用約2 000美元／d，延長(zhǎng)通氣者占總機(jī)械通氣患者的6％，但卻消耗ICU資源的37％。我國(guó)的撤機(jī)現(xiàn)狀與之類似，日益增多的撤機(jī)困難患者占用各ICU的有限資源，成為醫(yī)療費(fèi)用和床位周轉(zhuǎn)的沉重負(fù)擔(dān)。機(jī)械通氣撤離的研
究亟待加強(qiáng)。
引用本文： 俞森洋. 加強(qiáng)機(jī)械通氣撤離的研究. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2008, 08(4): 242-244. doi: 復(fù)制
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- 1. Epstein SK，Nevins ML，Chung J.Effect of unplanned extubation on outcome of mechanical ventilation.Am J Respir Crit Care Med，2000，161：1912-1916.
- 2. Esteban A，Anzueto A，F(xiàn)rutos F，et al．Mechanical ventilation international study group．Characteristics and outcomes in adult patients receiving mechanical ventilation：a 28-day international study．JAMA，2002，287：345-355．.
- 3. Cooper LM，Linde-Zwirble WT.Medicare intensive care unit use：analysis of incidence，cost，and payment.Crit Care Med，2004，32：2247-2253.
- 4. Wagner DP.Economics of prolonged mechanical ventilation.Am Rev Respir Dis，1989，140：S14-S18.
- 5. MacIntyre NR，Cook DJ，Ely EW Jr，et al.Evidence-based guidelines for weaning and discontinuing ventilatory support：a collective task force facilitated by the American College of Chest Physicians；the American Association for Respiratory Care；and the American College of Critical Care Medicine.Chest，2001，120(6 Suppl)：375S-395S.
- 6. Boles JM，Bion J，Connors A，et al.Weaning from mechanical ventilation.Eur Respir J，2007，29：1033-1056.
- 7. Saura P，Blanch L，Mestre J，et al.Clinical consequences of the implementation of a weaning protocol.Intensive Care Med，1996，22：1052-1056.
- 8. Krishnan JA，Moore D，Robeson C，et al.A prospective，controlled trial of a protocol-based strategy to discontinue mechanical ventilation.Am J Respir Crit Care Med，2004，169：673-678.
- 9. Burns KE，Adhikari NK，Meade MO.A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation.Can J Anesth，2006，53：305-315.
- 10. Peter JV，Moran JL，Phillips-Hughes J，et al.Noninvasive ventilation in acute respiratory failure--a meta-analysis update.Crit Care Med，2002，30：555-562.
- 11. Tobin MJ，Jubran A.Meta-analysis under the spotlight：focused on a meta-analysis of ventilator weaning.Crit Care Med，2008，36：1-7.