关键词: 脑梗死; 呼吸; 人工; 通气机; 负压

Abstract: Objective To evaluate the effects of predictors in the ventilator weaning process for patients with acute ischemic stroke.Methods Thirty acute ischemic stroke patients fulfilled the criteria of discontinuing ventilation have been evaluated by the screening test and spontaneous breathing trial. The patients were continuously observed and successful weaning was defined if the patient did not need ventilation after 48 hours. Failed weaning was assured if the patients were ventilated again in 48h and were evaluated 24 hours after the first weaning. Glasgow Coma Scale, vital signs, traditional weaning predictors, rapid shallow breathing index(RSBI) and their dynamic changes were collected before ventilation and ventilator weaning.Results Totally 38 weaning processes were carried out in 30 patients, with failed rate of 26.3%. Univariate analysis showed the average age, gastrointestinal hemorrhage, pulmonary infection, dynamic changes of GCS before and after ventilation were significantly associated with ventilation weaning in stroke patients(P<0.05). The successful group had lower RSBI and higher PaCO2 than the failed group before ventilation, and showed higher GCS, phosphorus, albumin, oxygen saturated index and lower temperature, dilated blood pressure, blood glucose and RSBI before weaning compared with the failed group. Logistic regression analysis showed RSBI, pulmonary infection and ΔGCS were the significant variables of weaning. By combining the three predictors, the sensitivity, specificity and accuracy were 85.7%, 70%, and 81.6% respectively.Conclusion RSBI, pulmonary infection and ΔGCS are valuable and accurate predictors in the weaning process for patients with acute ischemic stroke.

Key words: Brain infarction; Respiration artificial; Ventilators; negative-pressure