腹内压变化值在机械通气患者拔管决策中的应用 [中文引用][英文引用]

目的 探究拔管前腹内压变化值（delta intra-abdominal pressure，ΔIAP）对机械通气患者拔管失败率的影响，为临床护理决策提供参考。方法 选取 2022 年 7 月— 2024 年 1 月本市某三级乙等综合医院急诊 ICU 收治的 200 例机械通气患者为研究对象，按照随机数字表法分为试验组（n=100）和对照组（n=100）。对照组在通过自主呼吸试验（spontaneous breathingtrial，SBT）后拔除气管插管，试验组在通过 SBT 试验后测量 ΔIAP，若 ΔIAP>30mmHg 则拔除气管插管。比较两组患者拔管失败率、机械通气时间、呼吸机相关性肺炎（ventilator-associated pneumonia，VAP）发生率、ICU 住院天数、ICU 死亡率和住院费用。结果 试验组拔管失败率、ICU 住院费用低于对照组，两组比较，差异具有统计学意义（均 P<0.05）。两组患者机械通气时间、VAP 发生率、ICU 死亡率、ICU 住院天数比较，差异无统计学意义（均 P>0.05）。Kaplan-Meier 法分析显示，两组患者拔管后的平均无再插管时间比较，差异具有统计学意义（log-rank P=0.049）。结论 应用腹内压变化值可指导机械通气患者拔管，降低拔管失败率。

Objective To evaluate the effects of pre-extubation intra-abdominal pressure（IAP）on failure rate of extubation in patients with mechanical ventilation and to provide a reference for nursing practice. Methods From July 2022 to January 2024，a total of 200 patients with mechanical ventilation in the intensive care unit（ICU）of our hospital were included in this study. The patients were assigned to an experimental group（n=100）and a control group（n=100）with radom number table. Patients in the control group had extubation after passing a spontaneous breathing trial（SBT），while for those in the experimental group，IAP was taken after passing the SBT and the extubation was performed at IAP > 30 mmHg. The two groups were compared in terms of failure rate of extubation， duration of mechanical ventilation，incidence of ventilation-associated pneumonia（VAP），length of ICU stay，ICU mortality and cost of hospitalisation. Results The failure rate of extubation in the experimental group was lower than that in the control group，and the cost of hospitalisation in the experimental group were lower than that in the control group. There were statistically significant differences between the two groups（both P<0.05）. There was no statistically significant differences between the two groups in duration of mechanical ventilation，incidence of VAP，ICU mortality and length of ICU stay（all P > 0.05）. Kaplan-Meier analysis showed a statistically significant difference in the mean time without reintubation（cumulative probability of reintubation）between the two groups after extubation（log-rank P = 0.049）. Conclusion Intra-abdominal pressure can be used as an indicator for extubation in the patients with mechanical ventilation. It reduces the rate of extubation failure.