摘要
目的探讨重症监护室(ICU)机械通气患者行低水平压力支持通气(PSV)法与T管试验法的脱机成功率,并比较两种综合脱机参数[用力呼吸指数(CORE指数)、浅快呼吸指数(RSBI值)]预测患者脱机成功价值。方法回顾性分析2019年1月~2019年12月期间秦皇岛第一医院内科ICU收治的106例机械通气患者临床资料,根据脱机自主呼吸试验(SBT)模式不同,分为低水平压力支持通气组(PSV组)49例与T管试验法(T管组)57例,所有患者在SBT前记录脱机参数,并计算出CORE指数、RSBI值,比较PSV组与T管组一般资料、脱机参数、脱机成功率,分析PSV组及T管组脱机成功者与脱机失败者CORE指数、RSBI值差异,绘制受试者工作特征曲线(ROC曲线)分析两组CORE指数、RSBI值对脱机成功的预测价值。结果PSV组脱机成功率与T管组比较差异无统计学意义(P>0.05);PSV组与T管组性别、年龄、急性生理和慢性健康(APACHEII)评分、机械通气时间、VT、f、PaO2、PaCO2、PImax、RSBI值比较差异无统计学意义(P>0.05),但PSV组P0.1低于T管组、CORE指数大于T管组,差异均有统计学意义(P<0.05);106例患者中,脱机成功者CORE指数显著大于脱机失败者(P<0.05),RSBI值显著小于脱机失败组(P<0.05);患者整体CORE指数、RSBI值预测脱机成功的ROC曲线下面积分别为0.882、0.742;两组脱机成功者CORE指数均大于脱机失败者(P<0.05),RSBI值均小于脱机失败者(P<0.05);PSV组CORE指数、RSBI值预测脱机成功的ROC曲线下面积分别为0.966、0.792,T管组分别为0.805、0.686。结论ICU患者采取低水平PSV法或T管试验法对脱机成功率无明显影响,CORE指数、RSBI值均对脱机成功有一定预测价值,以CORE指数预测价值更高,且在行PSV法脱机时展现出更高的预测价值。
Objective To explore the weaning success rate of patients with mechanical ventilation in intensive care unit(ICU)under low-level PSV and T tube test and compare the value of two comprehensive weaning parameters(CORE index,RSBI value)in predicting the weaning success.Methods The clinical data of 106 patients with mechanical ventilation admitted to the ICU of First Hospital of Qinhuangdao from January 2019 to December 2019 were retrospectively analyzed.The patients were divided into low-level pressure support ventilation group(PSV group,49 cases)and T tube test method(T tube group,57 cases)according to the weaning SBT modes.The weaning parameters of all patients were recorded before SBT.The CORE index and RSBI value were calculated.The general data,weaning parameters and weaning success rate were compared between PSV group and T tube group.The differences in CORE index and RSBI value of patients with weaning success and patients with weaning failure were analyzed in PSV group and T tube group.The receiver operating characteristic curve(ROC curve)was drawn to analyze the predictive value of CORE index and RSBI value on weaning success in the two groups.Results There was no statistical difference in the weaning success rate between PSV group and T tube group(69.39%vs 64.91%)(P>0.05).There were no significant differences in the gender,age,APACHEII score,mechanical ventilation time,VT,f,PaO2,PaCO2,PImax and RSBI value between PSV group and T tube group(P>0.05),but P0.1 in PSV group was low than those in T tube group,and the CORE index was greater than that in T tube group(P<0.05).Among 106 patients,the CORE index in weaning success group was significantly greater than that in weaning failure group(P<0.05)while the RSBI value was significantly smaller than that in weaning failure group(P<0.05).The areas under the ROC curves of overall CORE index and RSBI value were 0.882 and 0.742 in predicting weaning success.The CORE index of patients with weaning success in the two groups was greater than that of patients with weanin
作者
孟超
范志强
佟庆
田颖
穆永茂
MENG Chao;FAN Zhiqiang;TONG Qing;TIAN Ying;MU Yongmao(ICU of Internal Medicine Department, The First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei, China;Department of Critical Care Medicine, Qian'an People's Hospital, Qian'an 064400, Hebei, China)
出处
《西部医学》
2021年第1期124-129,共6页
Medical Journal of West China
基金
秦皇岛市科学技术研究与发展计划项目(201902A201)。
关键词
机械通气
顺应性
氧合
呼吸频率
用力呼吸指数
浅快呼吸指数
自主呼吸试验
脱机
Mechanical ventilation
Compliance
Oxygenation
Respiratory rate
Forced breathing index
Rapid-shallow-breathing index
Spontaneous breathing trial
Weaning
