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目的评估自主呼吸试验(SBT)安全性筛查宽松标准在重症监护病房(ICU)撤机中应用的效用及其安全性。方法选取2010年12月至2011年5月入住浙江省中医院ICU的82例需行有创机械通气的患者,采用随机双盲对照的方法分为SBT安全性筛查宽松标准组(宽松标准组)42例和SBT安全性筛查传统标准组(传统标准组)40例。筛选后行SBT。试验通过则书面通知管床医生SBT安全性筛查标准结果,由管床医生决定何时撤机拔管。比较两组间的脱机状态维持时间、机械通气时间、ICU住院时间、28 d病死率、意外拔管和再插管率。结果宽松标准组较传统标准组脱机状态维持时间更长(25 d对21 d,P=0.000),机械通气时间缩短(3 d对7.5 d,P=0.000),ICU住院时间缩短(11 d对17 d,P=0.001),28 d病死率更低(14.3%对35.0%,P=0.029),意外拔管率(2.4%对7.5%,P=0.574)、再插管率(9.5%对7.5%,P=1.000)差异无统计学意义。结论 SBT安全性筛查宽松标准比SBT安全性筛查传统标准更有优越性,可以作为常规筛选标准应用于临床。
Objectives To evaluate the utility and safety of the Spontaneous Breath Test (SBT) Safe Screening Loose Standard in weaning of intensive care units (ICUs). Methods Eighty-two patients admitted to ICU of Zhejiang Provincial Hospital of Traditional Chinese Medicine from December 2010 to May 2011 were randomly divided into two groups: randomized double-blind control (SBT) safety screening loose standard group ) 42 cases and SBT safety screening 40 cases of traditional standard group (traditional standard group). After screening SBT. The test passes a written notification to the tube attending SBT safety screening standard results, the tube doctor decided when to weaning extubation. Offline maintenance, mechanical ventilation, ICU stay, 28-day mortality, accidental extubation and reintubation were compared between the two groups. Results Compared with the standard group, the standard group had longer maintenance time (25 days vs 21 days, P = 0.000), shorter duration of mechanical ventilation (3 days vs 7.5 days, P = 0.000), shorter hospital stay (11 days (P = 0.001). The mortality was lower at 28 days (14.3% vs 35.0%, P = 0.029), accidental extubation rate (2.4% vs 7.5%, P = 0.574) To 7.5%, P = 1.000), the difference was not statistically significant. Conclusion The SBT safety screening loose standard is superior to the traditional SBT safety screening standard and can be used as a routine screening standard in clinical practice.