Weaning failure from mechanical ventilation (MV) is not unifiedly defined yet now, generally it refers to that patients'spontaneous breathing cann' t meet requirement of their gas exchange and need repeated assistant ventilation within 48h after weaning.Some reporters indicated that weaning failure rate is 5％ to 29％ in children in pediatric intensive care unit (PICU), and weaning failure is an independent risk factor of increased mortality rate of children. So it' s most important to investigate factors of weaning failure, reduce the weaning failure rate and help children to wean MV early. The main causes of weaning failure include the child' s own factors, medical factors and social-family factors. In recent years, the factors of weaning failure have been further explored and some strategies have been proposed. As to explore causes of weaning failure from aspects such as oxidation and reduction system and enzymology, monitoring plasma levels of BNP is considered to help to diagnose cardiac weaning failure noninvasively and early, new weaning index-central venous saturation has been found out, and programmed ventilator weaning protocols have been proposed, etc.%机械通气撤机失败目前尚无统一定义,一般是指撤机后48h内患儿自主呼吸不能满足自身气体交换需要而需再次连接呼吸机.儿科重症监护室里患儿撤机失败率为5%～29%,撤机失败是导致儿童死亡率增高的独立危险因素,因此探索撤机失败的原因,降低撤机失败率,帮助患儿早日脱机尤为重要.撤机失败原因主要包括患儿自身因素、医疗方面因素及社会家庭因素.近年来对撤机失败因素的探索进一步深入,学者们也提出了很多新的对策,如从氧化还原系统、酶学等方面深入研究撤机失败原因,如监测血浆脑钠肽水平帮助无创早期诊断心源性撤机失败,如提出新的撤机指标中心静脉饱和度,提出程序化撤机协议等.
展开▼
