CAJ | 학술논문

目的：探讨中心静脉血氧饱和度（ ScvO2）对困难脱机患者脱机结果的预测价值。方法将184例困难脱机患者进行的214例次脱机，按脱机结果分为脱机成功组和脱机失败组，按疾病进行分层分析得到心功能不全组和非心功能不全组。观察断开呼吸机即刻的ScvO2与自主呼吸试验第30分钟（ SBT 30 min）的ScvO2及两者差值ΔScvO2，分析这三个参数与脱机结果的关系。结果所有214例次脱机SBT 30 min的ScvO2与ΔScvO2，脱机成功组分别为74．6％±6．6％和2．76±4．16，脱机失败组分别为71．4％±5．5％和4．63±3．71，P均＜0．05。ΔScvO2预测患者脱机失败的临界值为3．65％，敏感性为73．3％，特异性为60．3％。分层分析显示，心功能不全组脱机成功者SBT 30 min的ScvO2与ΔScvO2分别为73．6％±5．2％和2．61±3．13，脱机失败者分别为70．4％±5．2％和5．08±2．38，P＜0．05或P＜0．01。ΔScvO2预测心功能不全患者脱机失败的临界值为4．0％，敏感性为85．0％，特异性为73．6％；而在非心功能不全组没有差异。结论 SBT 30 min的ScvO2与ΔScvO2能够预测困难脱机患者的脱机结果，可将ΔScvO2≥4．0％作为预测心功能不全患者脱机失败的预测指标之一。
목적：탐토중심정맥혈양포화도（ ScvO2）대곤난탈궤환자탈궤결과적예측개치。방법장184례곤난탈궤환자진행적214례차탈궤，안탈궤결과분위탈궤성공조화탈궤실패조，안질병진행분층분석득도심공능불전조화비심공능불전조。관찰단개호흡궤즉각적ScvO2여자주호흡시험제30분종（ SBT 30 min）적ScvO2급량자차치ΔScvO2，분석저삼개삼수여탈궤결과적관계。결과소유214례차탈궤SBT 30 min적ScvO2여ΔScvO2，탈궤성공조분별위74．6％±6．6％화2．76±4．16，탈궤실패조분별위71．4％±5．5％화4．63±3．71，P균＜0．05。ΔScvO2예측환자탈궤실패적림계치위3．65％，민감성위73．3％，특이성위60．3％。분층분석현시，심공능불전조탈궤성공자SBT 30 min적ScvO2여ΔScvO2분별위73．6％±5．2％화2．61±3．13，탈궤실패자분별위70．4％±5．2％화5．08±2．38，P＜0．05혹P＜0．01。ΔScvO2예측심공능불전환자탈궤실패적림계치위4．0％，민감성위85．0％，특이성위73．6％；이재비심공능불전조몰유차이。결론 SBT 30 min적ScvO2여ΔScvO2능구예측곤난탈궤환자적탈궤결과，가장ΔScvO2≥4．0％작위예측심공능불전환자탈궤실패적예측지표지일。
Objective To evaluate the value of central venous oxygen saturation ( ScvO2 ) in predicting weaning out-come in difficult-to-wean patients .Methods Totally 184 patients took 214 cases of weaning .According to the weaning re-sults, they were divided into the weaning success group and weaning failure group , and also were stratified as cardiac dys-function group and non-cardiac dysfunction group .The ScvO2 at the moment of disconnecting the ventilator and at the 30th min of spontaneous breathing trial (SBT) and their difference of ΔScvO2 were observed, meanwhile, the relationship be-tween these three parameters and weaning outcome were analyzed in this study .Results The ScvO2 of SBT and ΔScvO2 of the 214 cases at the 30th min in the weaning success group and weaning failure group were respectively 74.6%±6.6%, 2.76 ±4.16 and 71.4%±5.5%, 4.63 ±3.71, (all P<0.05).The cut off value of ΔScvO2 in predicting weaning failure was 3.65%, the sensitivity was 73.3%and the specificity was 60.3%.Stratified analysis showed that:among the cardiac dysfunction patients , the ScvO2 of SBT and ΔScvO2 at the 30th min were 73.6%±5.2%and 2.61 ±3.13 in the weaning success group, while 70.4%±5.2%and 5.08 ±2.38 in the weaning failure group (P<0.05 or P<0.01).The cut off value ofΔScvO2 in predicting weaning failure of the cardiac dysfunction patients was 4.0%, the sensitivity was 85.0%and the specificity was 73.6%, but no difference was found in the non-cardiac dysfunction group .Conclusions The ScvO2 of SBT and ΔScvO2 at the 30 th min could predict weaning outcome of difficult-to-wean patients, and ΔScvO2≥4.0% could be regarded as a predictive factor of weaning failure in patients with cardiac dysfunction .