【摘要】：目的：評(píng)估血清氨基末端-腦鈉肽前體(NT-proBNP)水平和脈搏指示連續(xù)心輸出量(PiCCO)參數(shù)在困難撤機(jī)的危重患者中對(duì)撤機(jī)結(jié)局的預(yù)測(cè)價(jià)值。 方法：采用前瞻性觀察方法,納入2013年1月至2014年2月期間由湘雅醫(yī)院重癥醫(yī)學(xué)科收治的接受有創(chuàng)機(jī)械通氣超過24小時(shí)并行PiCCO股動(dòng)脈置管的成年患者。根據(jù)2001年美國(guó)撤機(jī)指南對(duì)達(dá)到撤機(jī)標(biāo)準(zhǔn)的患者施行自主呼吸試驗(yàn)(SBT),通過者予拔管并嚴(yán)密觀察48小時(shí)。分別比較不同SBT結(jié)局(成功／失敗)以及不同撤機(jī)結(jié)局(成功／失敗)患者的液體平衡、血?dú)夥治鼋Y(jié)果、NT-proBNP及PiCCO參數(shù)的差異,并評(píng)估各指標(biāo)對(duì)患者SBT結(jié)局或撤機(jī)結(jié)局的診斷或預(yù)測(cè)價(jià)值。 結(jié)果：共34例患者符合本研究納入標(biāo)準(zhǔn),包括男性20例(58.8%)和女性14例(41.2%),其平均APACHE Ⅱ評(píng)分為21.6±1.4分,進(jìn)行SBT前有創(chuàng)機(jī)械通氣的中位時(shí)間為67.5(39,528)小時(shí)。根據(jù)SBT結(jié)局,將患者分為SBT成功組(n=28例,82.4%)與SBT失敗組(n=6例,17.7%),對(duì)SBT結(jié)局具有較高診斷價(jià)值的指標(biāo)包括：SBT前24小時(shí)液體量[ROC曲線下面積(AUC)=0.815±0.107, P=0.017]、SBT前每日液體量(AUC=0.940±0.040, P=0.001). SBT開始前NT-proBNP (AUC=0.777±0.095, P=0.036)、SBT結(jié)束時(shí)NT-proBNP(AUC=0.875±0.060, P=0.004)、SBT過程中NT-proBNP變化量ANT-proBNP (AUC=0.964±0.032, P0.001)、SBT過程中全心舒張末容積指數(shù)(GEDVI)的變化量AGEDVI (AUC=0.818±0.091, P=0.016)、以及肺血管通透指數(shù)(PVPI)(AUC=0.905±0.061, P=0.002)。另外,根據(jù)拔管后48小時(shí)內(nèi)撤機(jī)結(jié)局將患者分為撤機(jī)成功組(n=16例,47.1%)與撤機(jī)失敗組(n=18例,52.9%),對(duì)撤機(jī)結(jié)局具有顯著的預(yù)測(cè)價(jià)值的指標(biāo)包括：SBT前每日液體量(AUC=0.733±0.090,P=O.021).△GEDVI(AUC=0.714±0.088,P=0.034).血管外肺水指數(shù)(EVLWI)(AUC=0.799±0.076,P=0.003)和PVPI(AUC=0.873±0.058, PO.001). 結(jié)論：與NT-proBNP或其他傳統(tǒng)容量指標(biāo)相比,PiCCO參數(shù)對(duì)困難撤機(jī)的危重患者撤機(jī)結(jié)局具有更高的預(yù)測(cè)價(jià)值。
[Abstract]:Objective: to evaluate the predictive value of serum amino-terminal brain natriuretic peptide precursor (NT-proBNP) and pulse indicator continuous cardiac output (PiCCO) parameters in patients with critical patients with difficult weaning. Methods: prospective observation was used to include adult patients who received invasive mechanical ventilation for more than 24 hours and PiCCO femoral artery catheterization from January 2013 to February 2014. According to the 2001 American guidelines for weaning, the patients who met the weaning standard were given extubation and closely observed for 48 hours if (SBT), passed. The fluid balance, blood gas analysis, NT-proBNP and PiCCO parameters of patients with different SBT outcomes (success / failure) and different weaning outcomes (success / failure) were compared, respectively. To evaluate the diagnostic and predictive value of each index in patients with SBT outcome or weaning outcome. Results: a total of 34 patients met the criteria of this study, including 20 males (58.8%) and 14 females (41.2%). The average APACHE 鈪，

本文編號(hào)：2275532