Effectiveness of sequential oxygen therapy post-extubation in patients at high risk of weaning failure identified early by SBT combined with diaphragmatic ultrasound
基于SBT联合膈肌超声早期识别撤机高风险患者拔管后序贯氧疗的有效性研究

摘要

目的 探究基于SBT联合膈肌超声早期识别撤机高风险患者拔管后序贯氧疗的有效性；方法 选取医院2024年1月-2024年9月的100例基于SBT联合膈肌超声早期识别撤机高风险患者，采用随机分组的方式，分为实验组和对照组各50例。两组患者符合拔管条件后，实验组在拔管后接受序贯氧疗，对照组则进行常规治疗。比较两组在血气分析参数、膈肌超声数据、并发症发生频率以及ICU住院时长方面的差异；结果 实验组患者的PaCO₂显著低于对照组，而PaCO₂则明显高于对照组，两组间差异具有统计学意义（P＜0.05）。实验组的并发症发生率为14%，低于对照组的20.00%，但差异未达到统计学显著性水平（P＞0.05）。实验组的膈肌移动度（DE）显著高于对照组，差异具有统计学意义（P＜0.05），而膈肌收缩速度（DCV）略低于对照组，但差异无统计学意义（P＞0.05）。实验组患者机械通气时间和住院时间明显少于对照组，差异有统计学意义（P＜0.05）；结论 基于SBT联合膈肌超声早期识别撤机高风险患者，在拔管后对其采用序贯氧疗，不仅可以改善患者血气分析指标和膈肌的移动度与收缩速度，同时还体现出较高的安全性。

Abstract

Objective To explore the effectiveness of sequential oxygen therapy after extubation in patients at high risk of weaning failure identified early by spontaneous breathing trial (SBT) combined with diaphragmatic ultrasound.
Methods One hundred patients identified as high-risk for weaning failure using SBT combined with diaphragmatic ultrasound from January 2024 to September 2024 in the hospital were enrolled. They were randomly divided into an experimental group (n=50) and a control group (n=50). After meeting extubation criteria, the experimental group received sequential oxygen therapy post-extubation, while the control group received conventional treatment. Differences between the two groups were compared regarding arterial blood gas (ABG) parameters, diaphragmatic ultrasound data, complication rates, and ICU length of stay.
Results PaCO₂ in the experimental group was significantly lower than in the control group, while PaO₂ was significantly higher, with statistically significant differences between the groups (P < 0.05). The complication rate in the experimental group was 14%, lower than the 20.00% in the control group, but this difference was not statistically significant (P > 0.05). Diaphragmatic excursion (DE) in the experimental group was significantly higher than in the control group, showing a statistically significant difference (P < 0.05). Diaphragmatic contraction velocity (DCV) was slightly lower in the experimental group compared to the control, but this difference was not statistically significant (P > 0.05). Mechanical ventilation duration and hospital stay were significantly shorter in the experimental group than in the control group, with statistically significant differences (P < 0.05).
Conclusion   For patients at high risk of weaning failure identified early by SBT combined with diaphragmatic ultrasound, implementing sequential oxygen therapy post-extubation not only improves ABG parameters and diaphragmatic function (excursion and contraction velocity) but also demonstrates a favorable safety profile.