CAJ | 학술논문

目的：探讨N末端B型脑钠肽(NT-proBNP)和呼吸用力(CORE)指数对心力衰竭(HF)患者机械通气撤机的预测价值。方法对46例机械通气时间>72 h的HF患者进行回顾性分析,当患者达到撤机条件行自主呼吸试验(SBT)前,抽血检测血浆NT-proBNP水平和动脉血气分析,并记录脱机参数,包括呼吸频率(f),动态顺应性(Cdyn),气道闭合压(P0.1),最大吸气压(PImax)等,计算CORE指数。根据撤机结局,将患者分为成功组和失败组,比较两组性别、年龄、撤机前急性生理与慢性健康评分(APACHE II评分)、NT-proBNP水平和CORE指数的差异。结果通过SBT试验的46例患者中,撤机成功有33例(71.74%)。两组性别、年龄和APACHE II评分差异均无统计学意义(P>0.05)；成功组NT-proBNP值相对较低, CORE指数则相对较高(P<0.01)。以NT-proBNP和CORE指数为协变量,利用logistic 模型对撤机结果进行预测,总准确率为93.48%(43/46),明显高于SBT试验的准确率(71.74%,P<0.05)。NT-proBNP预测撤机成功的ROC 曲线下面积(AUC)为0.88(95%可信区间为0.78~0.98,P<0.05),撤机成功的截点值为1372.73 pg/ml；CORE指数的AUC为0.94(95%可信区间为0.86~1.00,P<0.05),撤机成功的截点值为5.95。结论 NT-proBNP下降至1372.73 pg/ml, CORE指数上升至5.95,对于HF患者能成功撤离机械通气的预测价值较高,可作为撤机筛查指标。
목적：탐토N말단B형뇌납태(NT-proBNP)화호흡용력(CORE)지수대심력쇠갈(HF)환자궤계통기철궤적예측개치。방법대46례궤계통기시간>72 h적HF환자진행회고성분석,당환자체도철궤조건행자주호흡시험(SBT)전,추혈검측혈장NT-proBNP수평화동맥혈기분석,병기록탈궤삼수,포괄호흡빈솔(f),동태순응성(Cdyn),기도폐합압(P0.1),최대흡기압(PImax)등,계산CORE지수。근거철궤결국,장환자분위성공조화실패조,비교량조성별、년령、철궤전급성생리여만성건강평분(APACHE II평분)、NT-proBNP수평화CORE지수적차이。결과통과SBT시험적46례환자중,철궤성공유33례(71.74%)。량조성별、년령화APACHE II평분차이균무통계학의의(P>0.05)；성공조NT-proBNP치상대교저, CORE지수칙상대교고(P<0.01)。이NT-proBNP화CORE지수위협변량,이용logistic 모형대철궤결과진행예측,총준학솔위93.48%(43/46),명현고우SBT시험적준학솔(71.74%,P<0.05)。NT-proBNP예측철궤성공적ROC 곡선하면적(AUC)위0.88(95%가신구간위0.78~0.98,P<0.05),철궤성공적절점치위1372.73 pg/ml；CORE지수적AUC위0.94(95%가신구간위0.86~1.00,P<0.05),철궤성공적절점치위5.95。결론 NT-proBNP하강지1372.73 pg/ml, CORE지수상승지5.95,대우HF환자능성공철리궤계통기적예측개치교고,가작위철궤사사지표。
Objective To investigate the prediction value of N-terminal pro-brain natriuretic peptide (NT-proBNP) level and the compliance, oxygenation, respiration and effort (CORE) index for weaning of mechanical ventilation in patients with heart failure (HF).Methods A retrospective analysis was made with 46 HF patients with mechanical ventilation for more than 72 hours. When patients reached weaning criteria, before spontaneous breathing trials (SBT), plasma levels of NT-proBNP and blood gas analyses using arterial blood were measured, whilst weaning indexes, such as breathing rate (f), Lung dynamic compliance (Cdyn), Airway occlusion pressure (P0.1), Maximal inspiratory pressure (PImax), were recorded for calculation of CORE index. Based on weaning outcomes, all the patients were divided into success group and failure group, between which the age, gender, acute physiology and chronic health score (APACHE II), NT-proBNP levels and CORE indexes were compared.Results There were 46 cases passed the SBT test, and the weaning success rate was 71.74%. There were no statistical significance in the differences of age, gender and APACHE II score between the two groups (P>0.05). Lower levels of NT-proBNP and higher CORE indexes were observed in success group (P<0.01). With two covariates of NT-proBNP and CORE index, the total predicted percentage of correction was 93.48% (43/46) by logistic equation, which was significantly higher than that predicted by SBT (71.74%,P<0.05). The area under ROC curve (AUC) of NT-proBNP predicting successful weaning was 0.88 (95% CI 0.78~0.98;P<0.05) with a cutoff point of 1372.73 pg/ml. The AUC of CORE index was 0.94 (95% CI 0.86~1.00;P<0.05) with a cutoff point of 5.95.Conclusion Both NT-proBNP (<1372.73 pg/ml) and the CORE index (>5.95) were accurate indicators as predictors for successful weaning.