2024版《成人机械通气撤机临床实践指南：自主呼吸试验》解读

指南 呼吸内科· 呼吸衰竭与机械通气 · 2024
自主呼吸试验(spontaneous breathing trial,SBT)是评估患者自主呼吸功能与撤机可能性的有效方法。不恰当的SBT可能导致撤机过早或延迟,引发不良后果。规范实施SBT是临床实践的重要挑战。本文基于美国呼吸治疗学会(American Association for Respiratory Care, AARC)2024年发布的《成人机械通气撤机临床实践指南:自主呼吸试验》,解析SBT相关的4个临床问题,以期推动撤机的规范化实施,从而促进患者安全。
自主呼吸试验实践指南撤机

2024 版《成人机械通气撤机临床实践指南:自主呼吸试验》解读

俞超$^{1}$,金佳敏$^{1}$,周利$^{1}$,耿可$^{1}$,高春华$^{2}$

(1.浙江大学医学院附属第一医院重症医学科,浙江杭州 310003; 2.浙江大学医学院附属第一医院 护理部)

【摘要】 自主呼吸试验(spontaneous breathing trial,SBT)是评估患者自主呼吸功能与撤机可能性的有效方法。不恰当的SBT可能导致撤机过早或延迟,引发不良后果。规范实施SBT是临床实践的重要挑战。本文基于美国呼吸治疗学会(American Association for Respiratory Care, AARC)2024年发布的《成人机械通气撤机临床实践指南:自主呼吸试验》,解析SBT相关的4个临床问题,以期推动撤机的规范化实施,从而促进患者安全。

【关键词】 自主呼吸试验;实践指南;撤机

DOI: 10.3969/j.issn.2097-1826.2026.01.002

【中图分类号】 R473 【文献标识码】 A 【文章编号】 2097-1826(2026)01-0006-05

Interpretation of the 2024 "Clinical Practice Guideline: Spontaneous Breathing Trials for Libera- tion From Adult Mechanical Ventilation"

YU Chao$^{1}$, JIN Jiamin$^{1}$, ZHOU Li$^{1}$, GENG Ke$^{1}$, GAO Chunhua$^{2}$ (1. Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China; 2. Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine) Corresponding author: GAO Chunhua, Tel: 0571-87236631

[Abstract] The spontaneous breathing trial (SBT) is an effective method to assess patients' spontaneous respiratory function and the potential for weaning from mechanical ventilation. Inappropriate implementation of SBT may result in either premature or delayed weaning, leading to adverse outcomes. Standardizing the execution of SBT remains a significant challenge in clinical practice. Based on the 2024 "Clinical Practice Guideline: Spontaneous Breathing Trials for Liberation From Adult Mechanical Ventilation" issued by the American Association for Respiratory Care (AARC), this article analyzes 4 clinical issues related to SBT, with the aim of promoting standardized weaning practices and thereby ensuring patient safety.

[Key words] spontaneous breathing trial; practice guideline; weaning

撤机(撤离机械通气)是一项多阶段的临床实施过程,需依次经历患者生理状态的优化、自主呼吸试验(spontaneous breathing trial, SBT)适用性筛查、SBT执行及按管指征评估等关键环节[1]。相关研究[2]显示,护士和呼吸治疗师主导的标准化撤机比依赖医生判断的传统模式显著缩短ICU住院和机械通气时间。SBT作为其核心环节,为撤机决策提供了客观依据。然而,不同医疗机构在SBT的实施上仍存在显著差异。即便完成SBT,亦不意味必然成功撤机,撤机延迟或失败常受 SBT实施时机、团队决策信心、患者个体差异等多重混杂因素影响[3]。针对上述实践困境,美国呼吸治疗学会(American Association for Respiratory Care,AARC)组建了多学科指南制订委员会,严格遵循循证医学原则和系统化的指南制订流程,发

布了2024版《成人机械通气撤机临床实践指南:自主呼吸试验》[4] (以下简称“2024版指南”),系统解析 SBT 实践中的4个临床问题,明确相应的操作与建议。本文通过解读指南,提升临床工作者对 SBT的科学认知,促进其在临床中的规范应用。

1 指南发布背景

既往撤机指南呈现出明确的阶段性发展特征。2001年,由美国胸科医师学会(American College of Chest Physicians, ACCP), AARC 和美国重症医学院(American College of Critical Care Medicine, ACCM)联合发布的指南[6]确立了撤机基础框架,核心内容包括:动态评估患者 SBT 前准备状态、适时实施 SBT,以及分析 SBT 失败的潜在原因。2017年,ACCP 与美国胸科学会(American Thoracic Society, ATS)发布的更新版指南[6]在原有基础上进一步细化了临床实践内容,新增 SBT 具体操作建议,并加强对拔管失败高风险患者的管理指导。尽管现有指南提供了重要参考,但 SBT 的具体操作技术层

军事护理 Mil Nurs

January 2026,43(1)

·7·

面仍存在理解偏差与缺乏操作共识的问题。基于此,AARC 发布的2024版南聚聚焦于SBT临床实践细节,系统解析并回答了4个核心问题:(1)浅快呼吸指数(rapid shallow breathing index,RSBI)能否预测SBT的成功实施?(2)采用压力模式的SBT技术对撤机和拔管有无影响?(3)日间或夜间实施SBT对撤机有无影响?(4)SBT期间增加氧浓度能否提高撤机成功率?

2 机械通气撤机实施流程

基于研究证据与指南建议,撤机具体实施步骤详见图1。当导致呼吸衰发的2024版指南聚焦于SBT临床实测,总患者具备自主呼吸能力时,即自动撤机因素。首先依据客观标准评估者裁缴准备状态;其次结合临床证据与安全指标查 SBT适应证;最后通过降低或撤除呼吸机支持,评估患者对持续30~120 min SBT的耐受性,以判断拔管安全性。然而在临床实践中,SBT的准入标准、筛查频率、操作技术及实施时长仍存在学术会议,且患者异质性限制了标准流程的普遍适用。

3 指南核心问题解读

本指南由 AARC 指理委员会基于患者/人群干预措施对照结局 (population-intervention-com-parison-outcome, PICO) 的框架系统构建临床问题, 通过多学科专家的循证评估与共识讨论, 最终遴选出 SBT 临床实践中最具争议的 4 个核心问题, 提出相应建议, 具体如下。

3.1 不建议将RSBI作为启动 SBT的必要条件RSBI作为传统撤机预测指标,具有测量简便的优势,曾是临床应用最广泛的撤机生理指标。其核心作用体现在两方面:在撤机准备度评估中辅助判断患者对撤机的耐受性;作为SBT准入标准指导临床决策[7]。然而,有调查[8]显示,仅三分之一的受访者将RSBI作为SBT的准入标准。Tanios 等研究也表明,将RSBI纳入 SBT决策流程不仅延迟拔管时间,且无法降低按管失败率。近期1篇Meta分析[10]表明,阴性RSBI[≥105次呼吸/(min·L)]识别撤机失败的效能显著优于阳性RSBI[<105次呼吸/(min·L)]识别撤机成功的效能。早期研究[7]认为,当RSBI<105次/(min·L)时,预测拔管成功的敏感度为97%、特异度为64%,但后续研究[11]已对RSBI预测指标的有效性提出质疑,认为该指标混淆了撤机与拔管2个不同的临床评估维度,且现有证据未实证常规使用RSBI能缩短撤机时长。因此,“2024版指南”明确不建议将RSBI作为启动SBT的必要条件。多数情况下通过简单的临床筛查。

(如基础病因改善、氧合指数≥150 mmHg(1 mmHg=0.133 kPa)、动脉血pH>7.25、血流动力学稳定和自主呼吸能力)可判断患者是否具备 SBT条件,但仍需考虑患者异质性的影响。对于临界值病例或疑似神经性呼吸肌无力等特殊情况,使用RSBI或可提供辅助参考。未来研究应聚焦多模态预测模型,整合属超超声、电阻阻抗断层成像等客观指标,并探索特殊患者异质的 SBT决策路径,通过有

![graph TD\n A1[撤机准备度测试] --> A2[评估SBT适应症]\n A2 -->|不符合| A3[继续机械通气]\n A2 -->|符合| A4[进行2min SBT]\n A4 --> A5[RSBI<105次/min-L]\n A4 --> A12[1.RR>35次/min;2.SPO2<90%;3.HR>140次/min 或改变率>20%;4.SBP>180 mmHg 或<90 mmHg;5.烦躁，大汗或焦虑;6.RSBI≥105次/（min·L）]\n A5 --> A6[继续进行SBT(30~120)min]\n A5 --> A3\n A6 --> A7[1.动脉血气指标: FiO2≤0.4,PaO2≥50-60 mmHg,PH≥7.32,PaCO2增加≤10 mmHg;2.SpO2≥85%-90%;3.血流动力学指标稳定（HR<120-140 次/min且HR改变<20%、SBP<180-200 mmHg且血压变化<20%);4.呼吸（RR<30-35 次/min,RR 改变≤50%)]\n A7 --> A8[咳嗽反射足以清除呼吸道分泌物且有呼吸道保护能力]\n A8 -->|不佳| A3\n A8 -->|良好| A9[拔管]\n A9 --> A10[密切监测患者呼吸功能和呼吸道保护能力，必要时使用无创通气或高流量氧疗过渡支持]\n](1/parseimages/figure60ba0122d8604fbaaa265c124c72750c_0_10.png) 注:格拉斯哥昏迷指数(Glasgow coma scale, GCS);氧分压/氧浓度(partial pressure of oxygen/fractional inspired concentration of oxygen, PaO₂/FiO₂);二氧化碳分压(partial pressure of carbon dioxide, PaCO₂);氧饱和度(oxygen saturation, SpO₂);呼吸频率(respiratory rate,RR);呼气末正(positive end-expiratory pressure, PEEP);心率(heart rate, HR);收缩压(systolic blood pressure, SBP)

3.2 强调个体化选择,以决定是否采用低水平支持

SBT 实施技术在全球范围内存在显著地域差异,多项证据[12-16]表明,其技术选择应基于患者特征进行个体化决策。研究[17]发现,约49.10%的患者采用低水平压力支持通气(pressure support ventilation, PSV)联合PEEP技术,25.40%采用T管技术,持续正压通气(continuous positive airway pressure, CPAP)技术和单纯低水平 PSV技术分别占10.80%和9.50%。呼吸机支持方式具有两方面优势:(1)可有效减轻因气管导管内阻力(导管内径≤7 mm)所致的呼吸做功增加,吸气肌负荷加重,对撤机进程产生不利影响[18];(2)呼吸机的监测系统可在

·8·

军事护理 2026年1月,43(1)

患者呼吸频率、潮气量或每分钟通气量异常时及时向医护人员发出警报。多项系统综述[19-23]表明,采用PSV的SBT技术有更高的撤机成功率。但近期临床试验[14]证实,不同技术对ICU患者拨管时间及拔管成功率的影响差异无统计学意义(P>0.05)。

尽管PSV模式的SBT技术已被广泛采纳且证实具有良好的安全性,但目前仍缺乏高质量证据支持其具有更优的临床效益。因此,SBT技术选择需基于患者个体化评估。例如,长期机械通气患者因呼吸肌功能减退,若实施持续2h的T管SBT,易发生呼吸肌疲劳,从而增加撤机延迟的风险。ICU护士在此期间动态监测患者呼吸力学参数及疲劳状态,并据此调整SBT技术,可显著提高撤机效率[24]。再例如,一项针对拔管失败高风险患者的研究[15]表明,PSV撤机的效果显著优于T管。另有研究[16]发现,在特殊生理状态的患者中(>65岁和/或有基础慢性心脏或呼吸系统疾病),采用无PEEP的低水平PSV(8 cmH₂O)(1 cmH₂O=0.098 kPa)相较于T管,其初始SBT成功率(79% vs. 72%)、24 h拔管率(77% vs. 72%)及首次SBT后7d内累计拔管率(98% vs. 94%)等指标均显示出一定优势。临床实践中对PSV的SBT技术,存在2个常见的认知分区:(1)认为PSV模式中零设置(PS 0 cmH₂O,PEEP 0 cmH₂O)等同T管试验;(2)忽视呼吸管路自身特性所致的压力偏差[25]。Sameed等[26]通过呼吸力学模型验证发现,呼吸机在努力维持恒定回路压力的过程中仍可能施加弱压正,从而掩盖部分患者存在的隐匿性呼吸努力过载现象。更值得关注的是特定病理状态下的误判风险,即心力衰竭、慢性阻塞性肺疾病或存在内源性PEEP等特殊患者在接受低水平PSV时,可能出现SBT误判通过,进而增加重插管风险[27-28]。因此,“2024版指南”没有明确推荐PSV或T管哪项更优,强调个体化选择,建议若采用PSV技术,应根据病理特征决定是否保留低水平压力支持(吸气压力≤8 cmH₂O)。

3.3 推荐实施标准化评估,并在每日午前完成 SBT

临床实践表明,团队主导型撤机较传统医生判断模式更具时效优势[2]。既往研究[29]发现,呼吸治疗师主导的晨间 SBT 筛查,可明显缩短整体撤机时间。此后,许多ICU广泛采纳晨间 SBT 筛查方法,这不仅肯定了呼吸治疗师在撤机过程中的重要作用,也凸显了标准化流程对提高撤机效率的意义。然而,该研究尚未阐明 SBT 实施的具体时间节点对撤机成功率的影响。SBT的执行时机应综合评估患者的撤机准备度、筛查频率以及所在ICU的工作流程与操作规范,并与临床团队的日常运作模式相协

调。若采用晨间 SBT 筛查的标准化流程,ICU 护理团队则需优化管理镇痛镇静方案,在筛查 SBT 前评估患者镇静与镇痛水平,并及时调整药物走速,以确保呼吸治疗师能够顺利实施 SBT。多学科床旁查房多在上午进行,于查房前完成 SBT 可为团队提供客观决策依据。而且从生理学角度考虑,清晨皮质醇水平升高时,可增强呼吸中枢的敏感性,促进呼吸频率和深度的调整。每日筛查与高频筛查在撤机成功率方面无差异,因此推荐采用每日1次的筛查模式,以减少患者应激反应并提高护理资源利用效率。在撤机准备方面,有研究[30]报道,通过信息系统实时监测撤机相关参数并推送预警提示,可缩短机械通气时间及ICU住院时长,但其作用机制尚不明确,不确定是优化了撤机流程,还是仅提高了临床决策效率。目前,关于SBT实施时间节点的证据非常有限,特别是非晨间时段是否有其他优势仍需深入探讨。基于临床实践的可操作性考量,指南推荐实施标准化评估,并于每日午前完成 SBT,以确保与多学科查房决策的有效衔接。

3.4 不建议 SBT期间增加氧浓度 执行 SBT 前的氧合评估应遵循严谨的生理学标准,一般要求 SpO₂ > 90%,FiO₂ < 0.4 或 PaO₂/FiO₂ > 200 mmHg[13]。如患者 SpO₂ < 90%,将终止 SBT,但该阈值属性性标准[31]。手术过程中患者可能出现低氧血症,部分ICU为应对患者术后潜在的低氧风险,会在 SBT期间提高氧浓度以维持氧合指标达标,然而现有证据尚未证实调整供氧参数对 SBT结果具有显著影响[32]。相反氧浓度提升则可能导致 SBT假阳性[33]。以慢性代偿性低氧血症患者为例,其基线SpO₂为94%,当SpO₂下降至88%时,使用常规氧合标准来判断,则会终止SBT实施,导致撤机延迟,此时若提升氧浓度致SpO₂上升至100%,又会误判呼吸代偿能力,导致SBT假性通过,掩盖低氧性呼吸衰竭持续潜在的病理机制,传统氧合标准在该人群中存在双重局限性[34]。现行 SBT氧合阈值(SpO₂ > 90%和FiO₂ < 0.40)对慢性缺氧患者可能过于保守,需结合患者呼吸代偿能力进行动态评估。目前尚无关于在SBT期间提高氧浓度对患者结局影响的研究,缺乏高水平证据指导 SBT期间的氧合管理。因此,指南不建议在SBT期间增加氧浓度。未来需探究拔管后需要无创通气或高流量氧疗的患者在SBT期间适度增加氧浓度是否可提高撤机效率。

4 小结

呼吸治疗技术专业性强,该职业在西方已有80余年的发展历程,但我国呼吸治疗师的数量仍远不

军事护理 Mil Nurs

January 2026,43(1)

$\cdot$ 9 $\cdot$

能满足重症医学发展与临床需求,呼吸治疗队伍长期处于未专业化状态,目前国内大多数医院的呼吸治疗工作主要由ICU高年投资主承担。因此,提升对呼吸治疗相关专业的认知水平与专科技术能力,是ICU护理职业发展的重要方向,既带来机遇,也伴随挑战。

【参考文献】

[1] BURNS K E A, ROCHWERG B, SEELY A J E. Ventilator we- ning and extubation [J]. Crit Care Clin, 2024,40(2):391-408.

[2] GIRARD T D, ALHAZZANI W, KRESS J P, et al. An official American Thoracic Society/American College of Chest Physicians clinical practice guideline: liberation from mechanical ventilation in critically ill adults, Rehabilitation protocols, ventilator liberation protocols, and cuff leak tests[J]. Am J Respir Crit Care Med, 2017, 195(1): 120-133.

[3] BALAS M C-TATE J, TAN A, et al. Evaluation of the perceived barriers and facilitators to timely extubation of critically ill adults; an interprofessional survey [J]. Worldviews Evid Based Nurs, 2021,18(3):201-209.

[4] ROBERTS K J, GOODFELLOW L T, BATTEY-MUSE C M, et al. AARC clinical practice guideline; spontaneous breathing trials for liberation from adult mechanical ventilation[J]. Respir Care, 2024,69(7):891-901.

[5] MACLNTYRE N R, COOK D J, ELY E W J, et al. Evidence based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians, the American Association for Respiratory Care, and the American College of Critical Care Medicine [J]. Chest, 2001, 120(6 Suppl): 375S-395S.

[6] FAN E, ZAKHARY B, AMARAL A, et al. Liberation from mechanical ventilation in critically ill adults. An official ATS/ACCP clinical practice guideline [J]. Ann Am Thorac Soc, 2017, 14(3):441-443.

[7] YANG K L, TOBIN M J.A. prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation [J].N Engl J Med, 1991,324(21):1445-1450.

[8] BURNS K E A, RAPTIS S, NISENAUM R, et al. International practice variation in weaning weaning critically ill adults from invasive mechanical ventilation [J]. Ann Am Thorac Soc, 2018, 15(4):494-502.

[9] TANIOS M A, NEVINS M L, HENDRA K P, et al. A randomized controlled trial of the role of weaning predictors in clinical decision making[J]. Crit Care Med, 2006, 34(10):2530-2535.

[10] TRIVEDI V, CHAUDHURI D, JINAH R, et al. The usefulness of the rapid shallow breathing index in predicting successful extubation; a systematic review and Meta-analysis [J]. Chest, 2022, 161(1):97-111.

[11]MEADE M, GUYATT G, COOK D, et al. Predicting success in weaning from mechanical ventilation[J]. Chest, 2001, 120(6 Suppl);400-42S.

[12] OUELLETTE D R, PATEL S, GIRARD T D, et al. Liberation from mechanical ventilation in critically ill adults: an official American College of Chest Physicians/American Thoracic Society clinical practice guideline; inspiratory pressure augmentation during spontaneous breathing trials, protocols minimizing sedation, and noninvasive ventilation immediately after extubation [J].Chest, 2017,151(1):166-180.

[13] SUBIRA C, HERNANDEZ G, VAZQUEZ A, et al. Effect of pressure support vs T-Piece ventilation strategies during spontaneous breathing trials on successful extubation among patients receiving mechanical ventilation: a randomized clinical trial [J]. JAMA, 2019, 321(22): 2175-2182.

[14] BURNS K E A, WONG J, RIZI L, et al. Frequency of screening and spontaneous breathing trial techniques: a randomized clinical trial[J]. JAMA, 2024, 332(21):1808-1821.

[15] THILLE A W, COUDROY R, NAY M A, et al. Pressure-support ventilation vs T-Piece during spontaneous breathing trials before extubation among patients at high risk of extubation failure: a post-hoc analysis of a clinical trial[J].Chest, 2020, 158(4): 1446-1455.

[16] THILLE A W, GACOUIN A, COUDROY R, et al. Spontaneous-breathing trials with pressure-support ventilation or a T-Piece [J].N Engl J Med, 2022,387(20):1843-1854.

[17] BURNS K E A, RIZV L, COOK D J, et al. Ventilator weaning and discontinuation practices for critically ill patients [J]. JAMA, 2021,325(12):1173-1184.

[18] BURNS K E A, LAFRIENIER-ROULA M, HILL N S, et al. Frequency of screening and SBT technique trial-North American Weaning Collaboration (FAST-NAWC): an update to the protocol and statistical analysis plan [J].Trials, 2023,24(1):626-629.

[19] BURNS K E A, SOLIMAN I, ADHIKARI N K J, et al. Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and Meta-analysis [J]. Crit Care, 2017, 21(1): 127-137.

[20] LI YJ, H ZHANG D.Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and Meter analysis [J]. Crit Care, 2020, 24(1):67-76.

[21] CARDINAL-FERNANDEZ P, BOUGNAUD J, COUR M, et al. Automatic tube compensation during spontaneous breathing trials [J]. Respir Care, 2022,67(10):1335-1342.

[22] PELLEGRINI J A.MORAES R B, MACCARI J G, et al. Spontaneous breathing trials with piece or pressure support ventilation [J]. Respir Care, 2016, 61(12):1693-1703.

[23] YE X, WATERS D, YU H J. The effectiveness of pressure support ventilation and T-piece in differing duration among weaning patients: a systematic review and network Meta-analysis [J].Nurs Crit Care,2023,28(1):120-132.

[24]尹佳宁,管晓敏,张琦,等.ICU机械通气患者撤机后呼吸肌训练的循证实践[J].军事护理,2024,41(9):95-98.

[25] BROCHARD L, RUA F, LORINO H. Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube[J].Anesthesiology,1991,75(5):739-745.

[26] SAMEED M, CHATBURN R, L HATIPOGLU U. Bench assessment of work of breathing during a spontaneous breathing trial on zero pressure support and zero PEEP compared to T-Piece [J]. Respir Care, 2023,68(6):767-772.

[27] TOBIN M J. Estubation and the myth of "minimal ventilator settings"[J]. Am J Respir Crit Care Med, 2012, 185(4):349-350.

[28] REISSMANN H K, RANIERI V M, GOLDBERG P, et al. Con tinuous positive airway pressure facilitates spontaneous breathing in weaning chronic obstructive pulmonary disease patients by improving breathing pattern and gas exchange [J]. Intensive Care Med, 2000, 26(12): 1764-1772.

(下转第 19 页)

军事护理 Mil Nurs

January 2026,43(1)

$\cdot$ 19 $\cdot$

46(6):11-15. [17]林卫.陈宁园,全雪梅,等.体感互动游戏改善脑卒中患者运动功能的效果观察[J].广西医学,2018,40(14):1558-1561,1578. [18]刘洪富.互动情感游戏对脑卒中患者运动和平衡功能的康复效果观察[J].中国卫生标准管理,2016,7(1):69-70. [19]朱祥.王尚书.任丹丹,等.体感交互技术 Kinect 在脑卒中后下肢功能康复的应用[J].河北联合大学学报:医学版,2015,17(4):54-56. [20]SONG G B,PARK E.C.Effect of virtual reality games on stroke patients' balance, gait, depression, and interpersonal relationships[J]. J Phys Ther Sci,2015,27(7):2057-2060. [21]BARCALA L, GRECCO L A, COLELLA F, et al. Visual biofeed-back balance training using Wii fit after stroke: a randomized controlled trial[J]. J Phys Ther Sci,2013,25(8):1027-1032. [22]KARASU A U, BATUR E B,KARATA$G K.E.Effectiveness of Wir-based rehabilitation in stroke: a randomized controlled study[J]. J Rehabil Med,2018,50(5):406-412. [23]LEE H C.HUANG C L, HO S H, et al. The effect of a virtual reality game intervention on balance for patients with stroke: a randomized controlled trial[J]. Games Health J, 2017,6(5):303-311. [24]DA SILVA RIBEIRO N M, FERRAZ D D, PEDREIRA É, et al. Virtual rehabilitation via Nintendo Wi® and conventional physical therapy effectively treat post-stroke hemiparetic patients[J]. Top Stroke Rehabil,2015,22(4):299-305. [25]肖湘.黄东锋.梁斌.虚拟现实训练对亚急性期脑卒中患者上肢运动功能的影响[J].中国康复医学杂志,2019,34(9):1049-1053. [26]MARQUES-SULE E,ARNAL-GÓMEZ A, BUITRAGO-JIMÉNEZ G,et al.Effectiveness of Nintendo Wii and physical therapy in functionality, balance, and daily activities in chronic stroke patients[J]. J Am Med Dir Assoc,2021,22(5):1073-1080. [27]IKBALI AFSAR S, MIRZAYEV I, UMIT YEMISCI O, et al. Virtual reality in upper extremity rehabilitation of stroke patients: a randomized controlled trial[J]. J Stroke Cerebrovasc Dis,2018,27(12):3473-3478. [28]NOROUZI-GHEIDARI N, HERNANDEZ A, ARCHAMBAULT (上接第9页) [29]ELY E W, BAKER A M, DUNAGAN D P, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously[J]. N Engl J Med, 1996, 335(25): 1864-1869. [30]ANDERSON B J, DO D, CHIVERS C, et al. Clinical impact of an electronic dashboard and alert system for sedation minimization and ventilator liberation: a before-after study[J]. Crit Care Ex- explor,2019,1(10):1-8. [31]FERNANDEZ M M, GONZALEZ-CASTRO A, MAGRET M, et al. Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in criti-

P S, et al. Feasibility, safety and efficacy of a virtual reality exer game system to supplement upper extremity rehabilitation post-stroke: a pilot randomized clinical trial and proof of principle [J/AL. [2025-12-14]. https://pmc.ncbi.nlm.nih.gov/articles/PMC6981843/.DOI:10.3390/ijerph17010113. [29] JUNATA M, CHENG K C, MAN H S, et al. Kinect-based rapid movement training to improve balance recovery for stroke fall prevention: a randomized controlled trial [J/OL]. [2025-12-14]. https://pmc.ncbi.nlm.nih.gov/articles/PMC8503723/.DOI: 10.1186/12s984-021-00922-3. [30] SIN H, LEE G. Additional virtual reality training using Xbox Kinet in stroke survivors with hemiplegia [J]. Am J Phys Med Re-habil, 2013,92(10):871-880. [31] SULTAN N, KHUSHNOOD K, QURESHI S, et al. Effects of virtual reality training using Xbox Kinect on balance, postural control, and functional independence in subjects with stroke [J]. Games Health J, 2023,12(6):440-444. [32] PARK D S, LEE D G, LEE K, et al. Effects of virtual reality training using Xbox Kinect on motor function in stroke survi-vors: a preliminary study [J]. Stroke Cerebrovasc Dis, 2017, 26 (10): 2313-2319. [33] HUNG J W, CHOU C X, HSIEH Y W, et al. Randomized com-parison trial of balance training by using exergaming and conven-ational weight-shiler therapy in patients with chronic stroke [J]. Arch Phys Med Rehabil, 2014,95(9):1629-1637. [34] 杨莉,孙倩倩,戴薇,等.悬吊训练对脑卒中患者功能影响的系统评价[J].军事护理,2022,39(7):74-78. [35] 王明珠,胡思鸿,王琴,等.体感互动游戏 Wii 改善脑卒中病人康复效果研究进展[J].护理研究,2022,36(23):4228-4232. [36] HSIEH Y W, WANG C H, WU S C, et al. Establishing the mini-mal clinically important difference of the barthel index in stroke patients [J]. Neurorehabil Neural Repair, 2007,21(3):233-238. [37] 李晶晶,帕丽达·买买提,王宁宁,等.脑卒中足下垂患者日常生活活动能力现状及其影响因素分析[J].护理学报,2022,29(10):9-13.

(本文编辑:沈园园)

cally ill patients: a multicenter randomized controlled trial[J]. In-tensive Care Med, 2017, 43(11):1660-1667. [32] SORG M E, MCHENRY K L. Comparison of spontaneous breathing trials in clinical practice and current clinical practice guidelines [J]. Respir Care, 2025,70(5):477-484. [33] MARINI J J, GATTINONI L. The ventilator of the future: key principles and unmet needs [J]. Crit Care, 2024,28(1):284-289. [34] NAVALESI P, BRUNI A, GAROFALO E, et al. Weaning off mechanical ventilation: much less an art, but not yet a science [J]. Ann Transl Med, 2019.7(Suppl 8):S353-S357.

(本文编辑:沈园园)

相关指南

引用 / 出处

2024版《成人机械通气撤机临床实践指南：自主呼吸试验》解读. 2024.