中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2015年
6期
486-490
,共5页
程龙%姜利%王美平%董秉生%朱波%席修明
程龍%薑利%王美平%董秉生%硃波%席脩明
정룡%강리%왕미평%동병생%주파%석수명
通气,人工%呼吸试验%利钠肽,脑%通气机撤除法
通氣,人工%呼吸試驗%利鈉肽,腦%通氣機撤除法
통기,인공%호흡시험%리납태,뇌%통기궤철제법
Respiration,artificial%Breath test%Natriuretic peptide,brain%Ventilator weaning
目的 探讨自主呼吸试验(SBT)前后血浆B型利钠肽(BNP)变化对机械通气患者脱机的预测价值.方法 前瞻性队列研究.2013年7月-2014年1月收入首都医科大学附属复兴医院重症医学科的预计机械通气时间≥24 h者.依据SBT及脱机结局将患者分为SBT失败组、脱机失败组、脱机成功组.分别检测患者SBT前及SBT开始后2h血浆BNP水平,计算SBT前后BNP变化值(△BNP)及变化率(△BNP％).采用ROC曲线分析BNP变化对脱机的预测价值.结果 共入选56例患者,其中SBT失败组12例,脱机失败组11例,脱机成功组33例.脱机成功组△BNP[7.0(-1.2,45.5)ng/L]显著低于脱机失败组[88.0(58.0,140.0)ng/L,P＜0.05]、SBT失败组[46.0(17.5,91.2) ng/L;P＜0.001].脱机成功组△BNP％ [6.1(-2.1,11.5)％]显著低于脱机失败组[20.5(15.3,40.3)％;P＜0.001]、SBT失败组[24.3(13.0,32.5)％;P＜0.001].△BNP％预测脱机成功AUCRoC为0.88(95％ CI0.79 ～0.97;P＜0.001),临界值为13.4％,敏感性为84.8％,特异性为82.6％.△BNP预测脱机成功AUCRoC为0.80 (95％CI0.69～0.92;P＜0.001),临界值为80 ng/L,敏感性为93.4％,特异性为47.9％.结论 △BNP％和△BNP均有助于预测机械通气患者的脱机,而△BNP％预测效果优于△BNP.
目的 探討自主呼吸試驗(SBT)前後血漿B型利鈉肽(BNP)變化對機械通氣患者脫機的預測價值.方法 前瞻性隊列研究.2013年7月-2014年1月收入首都醫科大學附屬複興醫院重癥醫學科的預計機械通氣時間≥24 h者.依據SBT及脫機結跼將患者分為SBT失敗組、脫機失敗組、脫機成功組.分彆檢測患者SBT前及SBT開始後2h血漿BNP水平,計算SBT前後BNP變化值(△BNP)及變化率(△BNP％).採用ROC麯線分析BNP變化對脫機的預測價值.結果 共入選56例患者,其中SBT失敗組12例,脫機失敗組11例,脫機成功組33例.脫機成功組△BNP[7.0(-1.2,45.5)ng/L]顯著低于脫機失敗組[88.0(58.0,140.0)ng/L,P＜0.05]、SBT失敗組[46.0(17.5,91.2) ng/L;P＜0.001].脫機成功組△BNP％ [6.1(-2.1,11.5)％]顯著低于脫機失敗組[20.5(15.3,40.3)％;P＜0.001]、SBT失敗組[24.3(13.0,32.5)％;P＜0.001].△BNP％預測脫機成功AUCRoC為0.88(95％ CI0.79 ～0.97;P＜0.001),臨界值為13.4％,敏感性為84.8％,特異性為82.6％.△BNP預測脫機成功AUCRoC為0.80 (95％CI0.69～0.92;P＜0.001),臨界值為80 ng/L,敏感性為93.4％,特異性為47.9％.結論 △BNP％和△BNP均有助于預測機械通氣患者的脫機,而△BNP％預測效果優于△BNP.
목적 탐토자주호흡시험(SBT)전후혈장B형리납태(BNP)변화대궤계통기환자탈궤적예측개치.방법 전첨성대렬연구.2013년7월-2014년1월수입수도의과대학부속복흥의원중증의학과적예계궤계통기시간≥24 h자.의거SBT급탈궤결국장환자분위SBT실패조、탈궤실패조、탈궤성공조.분별검측환자SBT전급SBT개시후2h혈장BNP수평,계산SBT전후BNP변화치(△BNP)급변화솔(△BNP％).채용ROC곡선분석BNP변화대탈궤적예측개치.결과 공입선56례환자,기중SBT실패조12례,탈궤실패조11례,탈궤성공조33례.탈궤성공조△BNP[7.0(-1.2,45.5)ng/L]현저저우탈궤실패조[88.0(58.0,140.0)ng/L,P＜0.05]、SBT실패조[46.0(17.5,91.2) ng/L;P＜0.001].탈궤성공조△BNP％ [6.1(-2.1,11.5)％]현저저우탈궤실패조[20.5(15.3,40.3)％;P＜0.001]、SBT실패조[24.3(13.0,32.5)％;P＜0.001].△BNP％예측탈궤성공AUCRoC위0.88(95％ CI0.79 ～0.97;P＜0.001),림계치위13.4％,민감성위84.8％,특이성위82.6％.△BNP예측탈궤성공AUCRoC위0.80 (95％CI0.69～0.92;P＜0.001),림계치위80 ng/L,민감성위93.4％,특이성위47.9％.결론 △BNP％화△BNP균유조우예측궤계통기환자적탈궤,이△BNP％예측효과우우△BNP.
Objective To evaluate the value of the change of B-type natriuretic peptide(BNP) in predicting weaning outcome of patients with mechanical ventilation in ICU.Methods We carried out a prospective cohort study on patients in ICU at Fuxing Hospital from July 2013 to January 2014.Patients expected to use mechanical ventilation for more than 24 hours were enrolled in our study.The plasma concentration of BNP was measured at the beginning of spontaneous breathing trial(SBT) and 2 hours after.According to the outcome of SBT,patients were divided into SBT failure group (group A),weaning failure group (group B) and weaning success group (group C).The levels of BNP before and after the SBT were compared among three groups.The receiver operating characteristic (ROC) curve analysis was used to evaluate the changes of BNP (△BNP) and the rate of change (△BNP％) in predicting weaning outcome.Results A total of 56 patients were enrolled in our study,12 in group A,11 in group B and 33 in groupC.In groupC,both△BNPand△BNP％ [7.0,(-1.2,45.5) ng/L;6.1 (-2.1,11.5)％]were significantly lower than those in group A [88.0 (58.0,140.0) ng/L,P ＜ 0.05;20.5 (15.3,40.3) ％,P＜0.001]and group B[46.0 (17.5,91.2) ng/L,P＜0.001;24.3(13.0,32.5) ％,P＜0.001].The area under ROC curve (AUC) of △BNP％ to predict weaning success was 0.88 [95％ CI 0.79-0.97;P ＜0.001] and the cut-off value is 13.4％ with relatively high sensitivity(84.8％)and specificity(82.6％).The AUC of △BNP to predict weaning success was 0.80 [95％ CI 0.69-0.92;P ＜ 0.001] and the cut-off value is 80ng/L with high sensitivity 93.4％ and mediocre specificity (47.9％).Conclusion Either △BNP％ or △BNP in the SBT can predict weaning outcome,in which △BNP％ seems better than △BNP.
