本文選題：中心靜脈血氧飽和度 + 機(jī)械通氣�。� 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的探討中心靜脈血氧飽和度(central venous oxygen saturation,ScvO2)對(duì)困難脫機(jī)患者脫機(jī)結(jié)果的預(yù)測(cè)價(jià)值。 方法將184例困難脫機(jī)患者進(jìn)行的214例次脫機(jī),按脫機(jī)結(jié)果分為脫機(jī)成功組和脫機(jī)失敗組,按轉(zhuǎn)入ICU時(shí)是否患有心功能不全分層為心功能不全組和非心功能不全組。記錄患者的年齡、入院時(shí)的APACHEⅡ評(píng)分、死亡風(fēng)險(xiǎn)系數(shù)、脫機(jī)前的氧合指數(shù)(OI),在斷開(kāi)呼吸機(jī)即刻記錄患者的心率(HR)、呼吸頻率(RR)、血壓(Bp)、氧飽和度(SpO2),分別取外周動(dòng)脈血和中心靜脈血查血?dú)?得到動(dòng)脈血氧飽和度(SaO2)及ScvO2。在自主呼吸實(shí)驗(yàn)(spontaneous breathing trail,SBT)第30min時(shí)重復(fù)上述操作步驟,將斷開(kāi)呼吸機(jī)即刻的ScvO2減去SBT第30min的ScvO2,所得到的差值記為ΔScvO2。分析這些參數(shù)在脫機(jī)成功組與脫機(jī)失敗組之間的差異,判斷哪些指標(biāo)對(duì)脫機(jī)結(jié)果有影響。 結(jié)果(1)所有214例次脫機(jī)在SBT第30min的ScvO2與ΔScvO2在脫機(jī)成功組與脫機(jī)失敗組間有差異(74.6±6.6VS71.4±5.5,p0.05及2.76±4.16VS4.634±3.71, p0.05),其余各參數(shù)在脫機(jī)成功組與脫機(jī)失敗組之間無(wú)差異。ΔScvO2預(yù)測(cè)脫機(jī)失敗的臨界值為3.65%,敏感性為73.3%,特異性為60.3%。(2)分層分析顯示：僅有SBT第30min的ScvO2與ΔScvO2在心功能不全組脫機(jī)成功患者與脫機(jī)失敗患者間有差異(73.6±5.2VS70.4±5.2,p0.05與2.61±3.13VS5.08±2.38,p0.01),其余參數(shù)在心功能不全組以及非心功能不全組均沒(méi)有差異。ΔScvO2預(yù)測(cè)心功能不全患者脫機(jī)失敗的臨界值值為4.0%,敏感性為85.0%,特異性為73.6%。 結(jié)論SBT第30min的ScvO2與ΔScvO2能夠預(yù)測(cè)困難脫機(jī)患者的脫機(jī)結(jié)果；分層分析顯示SBT第30min的ScvO2和ΔScvO2僅對(duì)心功能不全患者脫機(jī)失敗有預(yù)測(cè)價(jià)值,可將ΔScvO2≥4.0%作為預(yù)測(cè)心功能不全患者脫機(jī)失敗的預(yù)測(cè)指標(biāo)之一。
[Abstract]:Objective to investigate the value of central venous oxygen saturation (scvO2) in predicting the weaning results in patients with difficult weaning. Methods one hundred and fourteen patients with difficulty weaning were divided into two groups according to the results of weaning: successful weaning group and failed weaning group. According to whether the patients suffered from cardiac insufficiency or not were divided into cardiac insufficiency group and non-cardiac insufficiency group according to whether they were suffering from cardiac insufficiency at the time of transfer to ICU. The age of the patient, the APACHE 鈪，

本文編號(hào)：1861013