CAJ | 학술논문

目的寻找机械通气自动管道补偿模式(ATC)下自主呼吸试验(SBT)过程中准确预测拔管成功的呼吸参数.方法前瞻性地选择符合撤机准入标准的机械通气患者共105例进行60 minATC模式下的SBT.SBT中持续监测心率(HR)、平均动脉压(MAP),1、30、60 min时记录分钟通气量(VE),呼吸频率(RR),自主呼吸潮气量(VT),计算呼吸浅快指数(RSBI)及各时点间的变化量和变化率(如ARSBI60_1和ARSBI60_1/RSBI).比较拔管成功组和拔管失败组的临床资料和SBT过程中各呼吸参数,ROC曲线下面积(AUC)评估各呼吸参数对成功拔管预测的准确性.结果拔管失败组的机械通气时间(10.8±2.7)d较拔管成功组长(7.5±5.1)d(P=0.035),拔管失败率为17.1％.在拔管成功组,SBT开始后随时间延长RSBI呈先增大后减少的趋势,而在拔管失败组,RSBI则持续增加,△RSBI60_1和△RSBI60_1/RSBI1在拔管成功组和失败组差异有统计学意义(-11.5±16.6:12.1 ±38.9,P=0.001;-17±26:13±39,P=0.028).RSBI60,△RSBI60_1和△RSBI60_1/RSBI1的AUC分别为0.75,0.73和0.72.△RSBI60_1/RSBI1≤0的敏感性、特异性和诊断准确性分别为81.0％、66.7％、78.5％.结论在ATC模式下动态观察SBT过程中各项呼吸参数很重要,△RSBI60_1和△RSBI60_1/RSBI1对拔管成功有预测价值,RSBI60趋于稳定或逐渐降低,拔管成功率越高.
목적 심조궤계통기자동관도보상모식(ATC)하자주호흡시험(SBT)과정중준학예측발관성공적호흡삼수.방법 전첨성지선택부합철궤준입표준적궤계통기환자공105례진행60 minATC모식하적SBT.SBT중지속감측심솔(HR)、평균동맥압(MAP),1、30、60 min시기록분종통기량(VE),호흡빈솔(RR),자주호흡조기량(VT),계산호흡천쾌지수(RSBI)급각시점간적변화량화변화솔(여ARSBI60_1화ARSBI60_1/RSBI).비교발관성공조화발관실패조적림상자료화SBT과정중각호흡삼수,ROC곡선하면적(AUC)평고각호흡삼수대성공발관예측적준학성.결과 발관실패조적궤계통기시간(10.8±2.7)d교발관성공조장(7.5±5.1)d(P=0.035),발관실패솔위17.1％.재발관성공조,SBT개시후수시간연장RSBI정선증대후감소적추세,이재발관실패조,RSBI칙지속증가,△RSBI60_1화△RSBI60_1/RSBI1재발관성공조화실패조차이유통계학의의(-11.5±16.6:12.1 ±38.9,P=0.001;-17±26:13±39,P=0.028).RSBI60,△RSBI60_1화△RSBI60_1/RSBI1적AUC분별위0.75,0.73화0.72.△RSBI60_1/RSBI1≤0적민감성、특이성화진단준학성분별위81.0％、66.7％、78.5％.결론 재ATC모식하동태관찰SBT과정중각항호흡삼수흔중요,△RSBI60_1화△RSBI60_1/RSBI1대발관성공유예측개치,RSBI60추우은정혹축점강저,발관성공솔월고.
Objective To determine the respiratory indices capable of improving predictive accuracy of extubation success through serial measurements of during spontaneous breathing trial (SBT) in automatic tube compensation (ATC) pattern of mechanical ventilation.Methods For this prospective observational study,patients ventilated over 48 hours were enrolled according to the weaning criterion and underwent a 60 minutes spontaneous breathing trial (SBT) in ATC pattern (ATC =100％,FiO2 =0.4,PEEP =0 cm H2O,PS =0 cm H2O).During SBT,heart rate (HR) and mean artery pressure (MAP) were monitored continuously and minute volume (VE),respiratory rate (RR),tidal volume of spontaneous breath (VT),rapid shallow breathing index (RSBI),change and rate of change (△RSBI60_ 1 and △RSBI60_1/RSBI1,etc.) were recorded or calculated at the first,30th and 60th minute of SBT.Patients tolerating the trial were extubated immediately.Clinical data and respiratory indices during SBT were compared between patients in extubation success group and those in extubation failure group.Predictive accuracy of extubation success was assessed by area under the receiver operating characteristic (ROC) curve (AUC) for each index.Results The duration of mechanical ventilation was longer in patients of extubation failure group than that of extubation success group (10.75 ± 2.73:7.47 ± 5.11,P =0.035) and extubation failure rate was 17.14％.During SBT,RSBI increased initially and then decreased in patients of extubation success group,but increased continuously in patients of extubation failure group.There were significant difference of △RSBI60_1 and △RSBI60_1/RSBII in patients between extubation success and failure groups (-11.5±16.6:12.1 ±38.9,P =0.001 and-17 ±26:13 ±39,P =0.028).AUCs of RSBI60,△RSBI60_1 and △RSBI60_1/RSBI1 were 0.75,0.73 and 0.72 and the sensitivity,specificity and diagnostic accuracy 81.0％,66.7％ and 78.5％ respectively.Conclusion It is important to observe change of various respiratory indices dynamically during SBT in patients ventilated in ATC pattern.△RSBI60_1 and △RSBI60_1/RSBI1 have greater predictive value for extubation success.Stable or decreased RSBI60 means higher extubation success rate.