摘要
目的建立膈肌增厚分数(DTF)与腹内压(IAP)监测导向的风险预测模型,探讨该模型对重症急性胰腺炎(SAP)患者撤机失败的预测价值。方法采用前瞻性研究方法,选择2020年8月至2021年10月锦州医科大学附属第一医院重症医学科收治的63例诊断为SAP并且行有创机械通气治疗的患者。在患者符合临床撤机标准时实施自主呼吸试验(SBT),将心血管状态稳定、肺功能状态良好、无胸腹矛盾运动、氧合充足定义为撤机成功,反之定义为撤机失败。比较撤机成功与失败两组患者的基线资料,以及SBT 30 min DTF、IAP、潮气量(VT)、呼吸频率(RR)、体质量指数(BMI)、血乳酸(Lac)等临床指标;将单因素分析中差异有统计学意义的指标纳入二分类多因素Logistic回归分析,建立风险预测模型。采用Pearson相关法分析SAP患者SBT 30 min DTF与IAP的相关性;绘制受试者工作特征曲线(ROC曲线),分析SAP患者SBT 30 min撤机失败风险预测模型的预测价值。结果63例SAP患者均纳入分析,其中撤机成功42例,撤机失败21例;两组年龄、性别及入院时氧合指数(PaO2/FiO2)、序贯器官衰竭评分(SOFA)和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)等基线资料比较差异均无统计学意义,说明两组资料具有可比性。与撤机成功组比较,撤机失败组患者SBT 30 min IAP、RR、BMI、Lac均显著升高〔IAP(mmHg,1 mmHg≈0.133 kPa):14.05±3.79比12.12±3.36,RR(次/min):25.43±8.10比22.02±5.05,BMI(kg/m^(2)):23.71±2.80比21.74±3.79,Lac(mmol/L):5.27±1.69比4.55±1.09,均P<0.05〕,而DTF和VT则显著降低〔DTF:(29.76±3.45)%比(31.86±3.67)%,VT(mL):379.00±98.74比413.60±33.68,均P<0.05〕。二分类多因素Logistic回归分析显示,DTF〔优势比(OR)=0.758,95%可信区间(95%CI)为0.584~0.983,P=0.037〕、IAP(OR=1.276,95%CI为1.025~1.582,P=0.029)和RR(OR=1.145,95%CI为1.014~1.294,P=0.029)为SAP患者SBT 30 min撤机失败的独立危险因素;采用上述危险因素建立SBT 30
Objective To establish a risk prediction model dominated by diaphragm thickening fraction(DTF)and intra-abdominal pressure(IAP)monitoring,and to explore the predictive value of the model for weaning failure in patients with severe acute pancreatitis(SAP).Methods A prospective research was conducted.Sixty-three patients undergoing invasive mechanical ventilation treatment who diagnosed with SAP admitted to intensive care unit of the First Affiliated Hospital of Jinzhou Medical University from August 2020 to October 2021 were enrolled.The spontaneous breathing trial(SBT)was carried out when the clinical weaning criteria was met.The stable cardiovascular status,good pulmonary function,no chest and abdominal contradictory movement,and adequate oxygenation were defined as successful weaning.Otherwise,it was defined as failure weaning.The clinical indicators such as SBT 30-minure DTF,IAP,tidal volume(VT),respiratory rate(RR),body mass index(BMI),and blood lactic acid(Lac)were compared between the weaning success group and the weaning failure group.The indicators with statistically significant differences in the single-factor analysis were included in the secondary multivariable Logistic regression analysis to establish a risk prediction model.The correlation between the DTF and IAP at 30 minutes of SBT was analyzed.Receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive value of the risk prediction model for SAP patient withdrawal failure at 30 minutes of SBT.Results Finally,63 patients with SAP were enrolled.Among the 63 patients,42 were successfully weaned and 21 failed.There were no significant differences in age,gender,and oxygenation index(PaO2/FiO2),sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score at admission between the two groups,indicating that the data in the two groups were comparable.Compared with the weaning success group,IAP,RR,BMI and Lac at 30 minutes of SBT in the weaning failure group were significantly incre
作者
邸兴伟
李晓东
李甜
付海燕
金永浩
陈希
汤雪荥
Di Xingwei;Li Xiaodong;Li Tian;Fu Haiyan;Jin Yonghao;Chen Xi;Tang Xuexing(Department of Critical Care Medicine,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,Liaoning,China;Department of Respiratory and Critical Care,the Third Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,Liaoning,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2023年第2期177-181,共5页
Chinese Critical Care Medicine
基金
辽宁省重点研发计划项目(2020JH2/10100017)。
关键词
重症急性胰腺炎
膈肌增厚分数
腹内压
撤机
风险预测
Severe acute pancreatitis
Diaphragm thickening fraction
Intra-abdominal pressure
Weaning
Risk prediction
