李莘　潘慧斌　姜燕　邹晓月　包芸

[摘要] 目的 探討标准化流程撤机智能软件在慢性阻塞性肺疾病急性发作（AECOPD）机械通气患者撤机中的应用效果。 方法 选取2018年6月至2019年6月入住我院EICU的68例AECOPD机械通气患者，按照智能软件使用时间将患者分成两组，其中将2018年6—12月根据医生经验主导撤机的32例患者设为对照组，另将2019年1—6月采用标准化流程智能软件撤机的36例患者设为观察组，比较两组患者机械通气时间、撤机成功率、呼吸机相关性肺炎（VAP）发生率、住院时间、住院费用、患者舒适度情况。 结果 ①两组患者入组时的一般资料、GCS评分以及危重症评分等比较，差异无统计学意义（P>0.05）;②观察组机械通气时间、住院时间均短于对照组，差异有统计学意义（P<0.05）;观察组VAP发生率及住院费用均低于对照组，差异有统计学意义（P<0.05）;而撤机成功率则高于对照组，差异有统计学意义（P<0.05）。③观察组患者的舒适度评分显著优于对照组，差异有统计学意义（P<0.05）。 结论 标准化流程撤机智能软件能规范AECOPD机械通气过程，系统评估患者病情，及时撤机，同时给予相应的撤机后序贯治疗，有助于机械通气患者的疾病转归及预后，提高患者住院期间的舒适度，改善护理结局，减少患者住院时间及费用，提高患者的生存质量，值得临床推广。

[关键词] 慢性阻塞性肺疾病;呼吸衰竭;机械通气;呼吸机撤机;舒适度

[中图分类号] R563          [文献标识码] A          [文章编号] 1673-9701（2021）11-0006-04

The application effect of standard process weaning intelligent software in weaning patients with acute exacerbation of chronic obstructive pulmonary disease with mechanical ventilation

LI Shen PAN Huibin JIANG Yan ZOU Xiaoyue BAO Yun

Department of Emergency Medicine， the First People′s Hospital of Huzhou City in Zhejiang Province， Huzhou   313000， China

[Abstract] Objective To investigate the application efficacy of standard process weaning intelligent software in weaning patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） with mechanical ventilation. Methods A total of 68 patients with AECOPD who were admitted to EICU of our hospital from June 2018 to June 2019 were selected and divided into two groups according to the application time of intelligent software. Among them， patients who took the doctor′s advice in weaning from June to December 2018 were included into the control group（n=32）， and those who took the standard process of intelligent software in weaning from January to June 2019 were included into the observation group（n=36）. Mechanical ventilation time，weaning success rate， incidence of ventilator-associated pneumonia（VAP）， hospitalization days， hospitalization expenses and comfort of patients were compared between the two groups. Results ①There were no significant differences in general data， GCS score and critical illness score between the two groups of patients（P>0.05）. ②The mechanical ventilation time and the hospitalization days were shorter than those in the control group，with statistically significant differences（P<0.05）. The VAP incidence  and hospitalization expenses in the observation group were both lower than those in the control group，with statistically significant differences（P<0.05）. While the success rate of weaning in the observation group was higher than that in the control group，with statistically significant differences（P<0.05）. ③The comfort score in the observation group was better than that in the control group，with statistically significant differences（P<0.05）. Conclusion Standard process weaning intelligent software can standardize the mechanical ventilation process of AECOPD， systematically evaluate the patient′s condition，wean the patient in time，and give corresponding sequential treatment after weaning，which is helpful to the disease outcome and prognosis of patients with mechanical ventilation，improve the comfort of patients during hospitalization， improve the nursing outcome， reduce the hospitalization time and expenses of patients，and raise the quality of life of patients. Therefore， it is worthy of clinical promotion.

[Key words] Chronic obstructive pulmonary disease; Respiratory failure; Mechanical ventilation; Ventilator weaning; Comfort

随着慢性阻塞性肺疾病（Chronic obstructive pulmonary disease，COPD）患者的逐年增多，慢性阻塞性肺疾病急性加重（Acute exacerbation of chronic obstructive pulmonary disease，AECOPD）已是COPD患者死亡的重要原因。对于此类患者的抢救与治疗，临床上常以机械通气治疗为主要辅助手段[1]。然而长期机械通气容易使患者形成呼吸机依赖而造成撤机困难，同时也容易出现呼吸机相关性肺炎（Ventilator-associated pneumonia，VAP），导致患者预后差[2]。因此如何把握时机，尽早撤机显得愈加重要。目前针对机械通气患者的撤机流程以自主呼吸试验作为判断标准，被广泛认同[3]，但临床医生因经验不足等原因并不能掌握患者撤机的最佳时机，且根据经验判断撤机时机，缺乏硬性指标，没有规范性，具有盲目性和危险性，不利于患者的疾病康复。基于……