中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
6期
339-342
,共4页
李智伯%高心晶%王东浩%张铂%张振平%胡忠民%徐磊%秦英智
李智伯%高心晶%王東浩%張鉑%張振平%鬍忠民%徐磊%秦英智
리지백%고심정%왕동호%장박%장진평%호충민%서뢰%진영지
呼吸综合指数%肺疾病,阻塞性,慢性%急性加重%机械通气%脱机%成功率
呼吸綜閤指數%肺疾病,阻塞性,慢性%急性加重%機械通氣%脫機%成功率
호흡종합지수%폐질병,조새성,만성%급성가중%궤계통기%탈궤%성공솔
Respiratory multiple index%Chronic obstructive pulmonary disease%Acute exacerbation%Mechanical ventilation%Weaning from mechanical ventilation%Successful rate
目的 探讨呼吸综合指数(CROP,顺应性、呼吸频率、氧合、压力)对慢性阻塞性肺疾病急性加重(AECOPD)机械通气患者脱机结果的预测价值.方法 采用前瞻性多中心研究,选择2010年9月至2012年10月5家三级甲等医院重症监护病房(ICU)215例AECOPD机械通气脱机患者,均因呼吸衰竭失代偿接受经口气管插管机械通气24h以上,意识清楚、合作,均通过30 min自主呼吸试验(SBT).脱机前测定最大吸气压(PImax),记录气道峰压(Ppeak)、总呼气末正压(PEEPtot)、潮气量(VT)、呼吸频率(f),检测动脉血气分析记录氧分压(PaO2)和二氧化碳分压(PaCO2),计算实际肺顺应性(Crs)和肺泡氧分压(PAO2).代入公式CROP=实际Crs× 1/f× PaO2/PAO2×PImax,计算得到CROP值,72 h内无需再插管为脱机成功.绘制受试者工作特征曲线(ROC线)分析CROP对AECOPD机械通气患者脱机成败的预测价值.结果 215例患者中182例脱机成功,33例失败.脱机成功和失败的患者在性别、年龄、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分等方面比较无统计学差异.失败组患者脱机前PaCO2(mm Hg,1 mm Hg=0.133 kPa)明显高于成功组(60.69±10.47比51.24±8.81,P＜0.05),CROP(ml·次-1·min-1)明显低于成功组(10.286±1.392比58.746±7.283,P＜0.01),机械通气时间(d)较成功组明显延长(10.28±3.94比6.21±2.87,P＜O.05).脱机成功与否的CROP最佳临界值为13.521 ml·次-1·min-1,当CROP≥13.521 ml·次-1·min-1时预测脱机成功的特异性为91.9％,敏感性为87.9％,阳性预测值为0.97,阴性预测值为0.58；比值比(OR)＜1,提示CROP是影响脱机结局的独立因素.结论 对于AECOPD机械通气患者,多数脱机参数有其限制性,而复合参数CROP预测脱机成功的敏感性及特异性均较高,对脱机是否成功有明确的指导价值,CROP≥13.521 ml·次-1·min-1时患者脱机成功率高,CROP＜13.521 ml·次-1·min-1时患者脱机失败率高.
目的 探討呼吸綜閤指數(CROP,順應性、呼吸頻率、氧閤、壓力)對慢性阻塞性肺疾病急性加重(AECOPD)機械通氣患者脫機結果的預測價值.方法 採用前瞻性多中心研究,選擇2010年9月至2012年10月5傢三級甲等醫院重癥鑑護病房(ICU)215例AECOPD機械通氣脫機患者,均因呼吸衰竭失代償接受經口氣管插管機械通氣24h以上,意識清楚、閤作,均通過30 min自主呼吸試驗(SBT).脫機前測定最大吸氣壓(PImax),記錄氣道峰壓(Ppeak)、總呼氣末正壓(PEEPtot)、潮氣量(VT)、呼吸頻率(f),檢測動脈血氣分析記錄氧分壓(PaO2)和二氧化碳分壓(PaCO2),計算實際肺順應性(Crs)和肺泡氧分壓(PAO2).代入公式CROP=實際Crs× 1/f× PaO2/PAO2×PImax,計算得到CROP值,72 h內無需再插管為脫機成功.繪製受試者工作特徵麯線(ROC線)分析CROP對AECOPD機械通氣患者脫機成敗的預測價值.結果 215例患者中182例脫機成功,33例失敗.脫機成功和失敗的患者在性彆、年齡、急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分等方麵比較無統計學差異.失敗組患者脫機前PaCO2(mm Hg,1 mm Hg=0.133 kPa)明顯高于成功組(60.69±10.47比51.24±8.81,P＜0.05),CROP(ml·次-1·min-1)明顯低于成功組(10.286±1.392比58.746±7.283,P＜0.01),機械通氣時間(d)較成功組明顯延長(10.28±3.94比6.21±2.87,P＜O.05).脫機成功與否的CROP最佳臨界值為13.521 ml·次-1·min-1,噹CROP≥13.521 ml·次-1·min-1時預測脫機成功的特異性為91.9％,敏感性為87.9％,暘性預測值為0.97,陰性預測值為0.58；比值比(OR)＜1,提示CROP是影響脫機結跼的獨立因素.結論 對于AECOPD機械通氣患者,多數脫機參數有其限製性,而複閤參數CROP預測脫機成功的敏感性及特異性均較高,對脫機是否成功有明確的指導價值,CROP≥13.521 ml·次-1·min-1時患者脫機成功率高,CROP＜13.521 ml·次-1·min-1時患者脫機失敗率高.
목적 탐토호흡종합지수(CROP,순응성、호흡빈솔、양합、압력)대만성조새성폐질병급성가중(AECOPD)궤계통기환자탈궤결과적예측개치.방법 채용전첨성다중심연구,선택2010년9월지2012년10월5가삼급갑등의원중증감호병방(ICU)215례AECOPD궤계통기탈궤환자,균인호흡쇠갈실대상접수경구기관삽관궤계통기24h이상,의식청초、합작,균통과30 min자주호흡시험(SBT).탈궤전측정최대흡기압(PImax),기록기도봉압(Ppeak)、총호기말정압(PEEPtot)、조기량(VT)、호흡빈솔(f),검측동맥혈기분석기록양분압(PaO2)화이양화탄분압(PaCO2),계산실제폐순응성(Crs)화폐포양분압(PAO2).대입공식CROP=실제Crs× 1/f× PaO2/PAO2×PImax,계산득도CROP치,72 h내무수재삽관위탈궤성공.회제수시자공작특정곡선(ROC선)분석CROP대AECOPD궤계통기환자탈궤성패적예측개치.결과 215례환자중182례탈궤성공,33례실패.탈궤성공화실패적환자재성별、년령、급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분등방면비교무통계학차이.실패조환자탈궤전PaCO2(mm Hg,1 mm Hg=0.133 kPa)명현고우성공조(60.69±10.47비51.24±8.81,P＜0.05),CROP(ml·차-1·min-1)명현저우성공조(10.286±1.392비58.746±7.283,P＜0.01),궤계통기시간(d)교성공조명현연장(10.28±3.94비6.21±2.87,P＜O.05).탈궤성공여부적CROP최가림계치위13.521 ml·차-1·min-1,당CROP≥13.521 ml·차-1·min-1시예측탈궤성공적특이성위91.9％,민감성위87.9％,양성예측치위0.97,음성예측치위0.58；비치비(OR)＜1,제시CROP시영향탈궤결국적독립인소.결론 대우AECOPD궤계통기환자,다수탈궤삼수유기한제성,이복합삼수CROP예측탈궤성공적민감성급특이성균교고,대탈궤시부성공유명학적지도개치,CROP≥13.521 ml·차-1·min-1시환자탈궤성공솔고,CROP＜13.521 ml·차-1·min-1시환자탈궤실패솔고.
Objective To study the result of respiratory multiple index (compliance,respiratory rate,oxygenation,pressure,CROP) in predicting weaning from mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods A prospective study was conducted.Two hundred and fifteen patients weaning from mechanical ventilation with AECOPD in intensive care unit (ICU) of five tertiary hospitals from September 2010 to October 2012 were enrolled.All of the AECOPD patients were troubled with respiratory failure and received non-invasive mechanical ventilation for more than 24 hours.They were conscious and cooperative at the time of extubation,and passed the spontaneous breathing trial (SBT) for 30 minutes.Before weaning,the maximal inspiratory pressure (PImax),the peak airway pressure (Ppeak),the total positive end expiratory pressure (PEEPtot),tidal volume (Vr) and respiratory frequency (f) were recorded; the arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were detected; the effective compliance of the respiratory system (Crs) and alveolar oxygen pressure (PAO2) were calculated.The above indexes were substituted into the formula:CROP =Crs ×1/f× PaO2 / PAO2 × PImax to get the value of CROP.Successful weaning from mechanical ventilation was defined if there was no indication for intubation within 72 hours.The receiver operating characteristic curve (ROC curve) was drawn to analyze the predict value of CROP on result of weaning from mechanical ventilation in patients with AECOPD.Results In 215 patients,182 patients successfully weaned from mechanical ventilation,and 33 failed.There were no significant differences in gender,age and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score between the successfully weaned patients and the failed.Before weaning from mechanical ventilation,PaCO2 (mm Hg,1 mm Hg=0.133 kPa) in failed group was significandy higher than that in successful group (60.69 ±10.47 vs.51.24 ± 8.81,P＜0.05),the CROP (ml·breath-1 ·min-1) was significantly lowered (10.286 ± 1.392 vs.58.746 ± 7.283,P＜0.01),and the duration of mechanical ventilation (days) was prolonged (10.28 ± 3.94 vs.6.21 ± 2.87,P＜0.05).The best critical value of CROP which could predict the result of weaning from mechanical ventilation was 13.521 ml ·breath-1 ·min-1.CROP ≥13.521 ml ·breath-1 ·min-1 had a specificity of 91.9％ and sensitivity of 87.9％ in predicting extubation succeed.The positive predicted value was 0.97,and the negative predicted value was 0.58 ; Odds ratio (OR) ＜ 1,which confirmed that CROP was a strong and independent predictor of extubation.Conclusions For the AECOPD patients received mechanical ventilation,most extubation parameter was limited.Complex parameter of CROP has higher specificity and sensitivity,and has important value in predicting extubation outcome.When CROP ≥ 13.521 ml· breath-1· min-1,the successful rate is high,otherwise the rate is low.
