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.