浅快指数与N端脑钠素前体结合在指导慢性阻塞性肺疾病呼吸衰竭患者呼吸机撤离中的应用价值
|
摘要
目的探讨浅快指数(RSBI)与N端脑素前体(NT-proBNP)结合对于指导慢性阻塞性肺疾病(COPD)呼吸衰竭机械通气患者呼吸机撤离的价值。方法选择2015年1月1日～2018年1月1日我院收治的78例COPD呼吸衰竭机械通气患者作为研究对象,按呼吸机初次撤离结局分为撤离成功组(61例)及失败组(17例),比较两组达脱机条件时RSBI与NT-proBNP的差异,采用Logistic多元回归分析RSBI、NT-proBNP及两者联合检测对于指导COPD呼吸衰竭患者呼吸机撤离的意义。结果成功组与失败组的RSBI分别为(81.25±10.12)、(110.01±20.13)次/(min·L),成功组与失败组的NT-proBNP分别为(299.26±131.62)、(1286.29±256.16)pg/ml。成功组的RSBI与NTproBNP均低于失败组,差异有统计学意义(P<0.05)。Logistic多元回归分析显示RSBI、NT-proBNP及两者联合对于成功指导呼吸机撤离的相对危险度OR分别为5.236、2.762及6.785(P<0.05),两者联合预测呼吸机撤离价值更高。结论结合分别衡量呼吸肌储备功能的RSBI与评估心功能状态的NT-proBNP可提高COPD呼吸衰竭机械通气患者呼吸机撤离成功率。
Objective To assess the value of combination of rapid shallow breathing index(RSBI) and plasma N-terminal-pro-brain natriuretic peptide(NT-proBNP) for ventilator weaning to chronic obstructive pulmonary disease(COPD)patients with respiratory failure.Methods A total of 78 COPD patients with respiratory failure admitted in our hospital from 1 January 2015 to 1 January 2018 were selected as the research objects,they were divided into the success group(61 cases) and the failure group(17 cases) according to the weaning outcome at the first time.The difference of RSBI and plasma NT-proBNP were compared between the two groups when offline conditions were reached.Logistic multiple regression analysis was used to analyze the significance of RSBI,NT-proBNP and their combined detection in guiding ventilator evacuation in COPD patients with respiratory failure.Results The RSBI of the success group and the failure group were(81.25±10.12) times/(min·L),(110.01±20.13) times/(min·L),respectively.The level of NT-proBNP in the success group and the failure group were(299.26±131.62) pg/ml and(1286.29±256.16) pg/ml,respectively.The levels of RSBI and NT-proBNP in the successful group were lower than those in the failure group,and the difference was statistically significant(P<0.05).Logistic multivariate regression analysis showed that the relative risks OR of RSBI,NTproBNP and their combination for successful ventilator evacuation were 5.236,2.762 and 6.785,respectively(P<0.05).The combination of the two methods was more valuable in predicting ventilator evacuation.Conclusion Respiratory muscle reserve function measured by RSBI and cardiac function assessed by NT-proBNP can improve the success rate of ventilator evacuation in COPD patients with respiratory failure and mechanical ventilation.
Objective To assess the value of combination of rapid shallow breathing index(RSBI) and plasma N-terminal-pro-brain natriuretic peptide(NT-proBNP) for ventilator weaning to chronic obstructive pulmonary disease(COPD)patients with respiratory failure.Methods A total of 78 COPD patients with respiratory failure admitted in our hospital from 1 January 2015 to 1 January 2018 were selected as the research objects,they were divided into the success group(61 cases) and the failure group(17 cases) according to the weaning outcome at the first time.The difference of RSBI and plasma NT-proBNP were compared between the two groups when offline conditions were reached.Logistic multiple regression analysis was used to analyze the significance of RSBI,NT-proBNP and their combined detection in guiding ventilator evacuation in COPD patients with respiratory failure.Results The RSBI of the success group and the failure group were(81.25±10.12) times/(min·L),(110.01±20.13) times/(min·L),respectively.The level of NT-proBNP in the success group and the failure group were(299.26±131.62) pg/ml and(1286.29±256.16) pg/ml,respectively.The levels of RSBI and NT-proBNP in the successful group were lower than those in the failure group,and the difference was statistically significant(P<0.05).Logistic multivariate regression analysis showed that the relative risks OR of RSBI,NTproBNP and their combination for successful ventilator evacuation were 5.236,2.762 and 6.785,respectively(P<0.05).The combination of the two methods was more valuable in predicting ventilator evacuation.Conclusion Respiratory muscle reserve function measured by RSBI and cardiac function assessed by NT-proBNP can improve the success rate of ventilator evacuation in COPD patients with respiratory failure and mechanical ventilation.
引文
[1]王志力,李建国,邓彬,等.评价膈肌浅快指数与膈肌增厚分数在机械通气撤机中的诊断价值[J].中国急救医学,2018,38(5):385-389.
[2]王常永,范学明,翁方中,等.慢性阻塞性肺疾病并呼吸衰竭患者有创机械通气撤机失败的影响因素研究[J].实用心脑肺血管病杂志,2017,25(1):46-49.
[3]老年慢性阻塞性肺疾病急性加重患者撤机过程中血浆BNP水平检测的临床意义分析[J].心理医生,2018,24(15):111-112.
[4]张秀珍,陈丽霞,梁伟华,等.自主呼吸试验前后N端脑钠肽前体差值对非心源性危重机械通气患者撤机结局的预测价值[J].中国当代医药,2015,22(23):25-27.
[5]封凯旋,马斌,黄晓丽,等.血浆NT-proBNP检测在AECOPD呼吸衰竭治疗中的临床价值研究[J].医学研究杂志,2015,44(4):79-81.
[6]唐超,徐红.射血分数正常的老年心力衰竭患者血NTproBNP、Cys-C及Hcy的测定及其临床意义[J].医学信息,2017,30(8):15-17.
[7]中华医学会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(210年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[8]吴芳,韦卫琴,梁显泉.慢性阻塞性肺疾病撤机困难原因分析及对策[J].医药前沿,2017,7(16):111-113.
[9]翟文庆,刘强,张绍权,等.慢性阻塞性肺疾病急性加重期患者机械通气撤机失败的可能性因素分析[J].中外医学研究,2018,16(14):4-7.
[10]中华医学会重症医学分会.慢性阻塞性肺疾病急性加重患者的机械通气指南(2007)[J].中国危重病急救医学,2007,19(9):313-518.
[11]林传焕,刘毅君,谷欣.气道闭合压、最大吸气压和呼吸浅快指数对慢阻肺患者撤机的预测价值[J].临床肺科杂志,2016,21(12):2240-2243.
[12]方旭晨,叶旭辉,涂春莲,等.床旁超声心动图评价心功能不全患者呼吸机撤离失败原因[J].检验医学与临床,2018,15(4):507-509.
[13]郎琴,梁宗安.机械通气导致肺水肿的研究[J].中国呼吸与危重监护杂志,2015,14(6):621-625.
[14]赵珂,杨静,张丽,等.BNP对COPD机械通气患者撤机失败的预测作用[J].当代医学,2017,23(15):36-39.
[15]史克洁,施乾坤,穆心苇.脑钠肽对机械通气患者撤机的指导意义[J].医学综述,2016,22(8):1530-1531.
[16]温晓辉,陈杰,曹霖,等.NT-proBNP对自主呼吸试验后再插管事件的预测作用[J].临床医药文献电子杂志,2015,2(9):1665-1666.
[17]宋静杰,路雅宁.利钠肽与机械通气撤机结局[J].现代医院,2017,17(4):531-539.
[18]Armand MD,Ferran RC,Achille K,et al.Natriuretic peptide-driven fluid managament during ventilator weaning[J].Am J Respir Crit Care Med,2012,186(12):1256-1263.
[2]王常永,范学明,翁方中,等.慢性阻塞性肺疾病并呼吸衰竭患者有创机械通气撤机失败的影响因素研究[J].实用心脑肺血管病杂志,2017,25(1):46-49.
[3]老年慢性阻塞性肺疾病急性加重患者撤机过程中血浆BNP水平检测的临床意义分析[J].心理医生,2018,24(15):111-112.
[4]张秀珍,陈丽霞,梁伟华,等.自主呼吸试验前后N端脑钠肽前体差值对非心源性危重机械通气患者撤机结局的预测价值[J].中国当代医药,2015,22(23):25-27.
[5]封凯旋,马斌,黄晓丽,等.血浆NT-proBNP检测在AECOPD呼吸衰竭治疗中的临床价值研究[J].医学研究杂志,2015,44(4):79-81.
[6]唐超,徐红.射血分数正常的老年心力衰竭患者血NTproBNP、Cys-C及Hcy的测定及其临床意义[J].医学信息,2017,30(8):15-17.
[7]中华医学会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(210年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[8]吴芳,韦卫琴,梁显泉.慢性阻塞性肺疾病撤机困难原因分析及对策[J].医药前沿,2017,7(16):111-113.
[9]翟文庆,刘强,张绍权,等.慢性阻塞性肺疾病急性加重期患者机械通气撤机失败的可能性因素分析[J].中外医学研究,2018,16(14):4-7.
[10]中华医学会重症医学分会.慢性阻塞性肺疾病急性加重患者的机械通气指南(2007)[J].中国危重病急救医学,2007,19(9):313-518.
[11]林传焕,刘毅君,谷欣.气道闭合压、最大吸气压和呼吸浅快指数对慢阻肺患者撤机的预测价值[J].临床肺科杂志,2016,21(12):2240-2243.
[12]方旭晨,叶旭辉,涂春莲,等.床旁超声心动图评价心功能不全患者呼吸机撤离失败原因[J].检验医学与临床,2018,15(4):507-509.
[13]郎琴,梁宗安.机械通气导致肺水肿的研究[J].中国呼吸与危重监护杂志,2015,14(6):621-625.
[14]赵珂,杨静,张丽,等.BNP对COPD机械通气患者撤机失败的预测作用[J].当代医学,2017,23(15):36-39.
[15]史克洁,施乾坤,穆心苇.脑钠肽对机械通气患者撤机的指导意义[J].医学综述,2016,22(8):1530-1531.
[16]温晓辉,陈杰,曹霖,等.NT-proBNP对自主呼吸试验后再插管事件的预测作用[J].临床医药文献电子杂志,2015,2(9):1665-1666.
[17]宋静杰,路雅宁.利钠肽与机械通气撤机结局[J].现代医院,2017,17(4):531-539.
[18]Armand MD,Ferran RC,Achille K,et al.Natriuretic peptide-driven fluid managament during ventilator weaning[J].Am J Respir Crit Care Med,2012,186(12):1256-1263.