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Application of multi-predictors in the ventilator weaning process
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- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF TUBERCULOSIS AND RESPIRATORY DISEASES
- Issue:
- 12
- DOI:
- 10.3760/j:issn:1001-0939.2004.12.011
- Key Word:
- 浅快呼吸指数;气道闭合压;机械通气;呼吸机撤离
Abstract： 目的在长时间机械通气患者撤离呼吸机(简称撤机)时,评价浅快呼吸指数(RSBI)、气道闭合压(P0.1)及常规撤机参数的价值.方法采用前瞻性研究方法,对通过自主呼吸试验并满足常规撤机标准的80例患者,检测呼吸运动协调性、痰量、肺部啰音、咳嗽能力、呼吸频率(RR)、潮气量(VT)、分钟通气量(MV)、呼吸系统顺应性(C)、经皮脉搏容积血氧饱和度(SpO2)、动脉血pH值等10项常规撤机参数及RSBI和P0.1.根据撤机结果分为失败组和成功组.采用单因素(t检验、χ2检验)及多因素Logistic回归进行统计学分析.结果 16例患者撤机失败.单因素分析显示撤机失败组与成功组之间的年龄、RSBI和P0.1差异有显著性(P<0.05).以撤机结果为因变量进行Logistic回归分析显示:仅RSBI和P0.1是回归模型中差异有显著性的两个参数.两组RSBI分别是(71±23)次·min-1·L-1和(53±13)次·min-1 ·L-1(OR＝1.03),P0.1分别是(7.4±2.1)cm H2O和(3.6±1.4)cm H2O(OR＝6.87).以RSBI≤105 次·min-1·L-1为标准,预测撤机成功的敏感性为90%,特异性为36%,准确性为78%.以P0.1≤4.5 cm H2O为标准,预测撤机成功的敏感性为87%,特异性为66%,准确性为82%.10项常规参数中无一项差异有显著性.结论长时间机械通气患者撤机时,RSBI和P0.1对判断撤机能否成功有价值,而常规撤机参数价值有限.
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