P(Aa)O2、CVP联合IWI对重症颅脑损伤机械通气患者撤机的指导意义  

Guiding significance of P(Aa)O2 and CVP combined with IWI in weaning from mechanical ventilation of patients with severe craniocerebral injury

作　　者：康琦[1] 张细学 郭东风[1] 陈果 KANG Qi;ZHANG Xixue;GUO Dongfeng;CHEN Guo(Department of Emergency,Shanghai Pudong New Area Gongli Hospital,Shanghai,200135,China;Department of Aanesthesiology,Huadong Hospital Affiliated to Fudan University)

机构地区：[1]上海市浦东新区公利医院急诊科,上海200135 [2]复旦大学附属华东医院麻醉科

出　　处：《临床急诊杂志》2020年第2期106-110,共5页Journal of Clinical Emergency

摘　　要：目的:探讨肺泡-动脉氧分压差[P(Aa)O2)]、中心静脉压(CVP)联合综合脱机指数(IWI)对重症颅脑损伤机械通气患者撤机的指导意义。方法:对118例重症颅脑损伤机械通气患者的临床资料进行回顾性分析,统计撤机失败率,对比撤机成功与撤机失败两组患者撤机前P(Aa)O2、CVP、IWI水平情况,分析撤机前P(Aa)O2、CVP、IWI对重症颅脑损伤患者撤机失败的预测价值。结果:118例重症颅脑损伤机械通气患者中共有24例发生撤机失败情况,发生率为20.34%;撤机成功组P(Aa)O2、CVP均低于撤机失败组(P<0.05),撤机成功组IWI高于撤机失败组(P<0.05);P(Aa)O2、CVP、IWI预测重症颅脑损伤患者撤机失败的最佳截断点分别为22.12 mmHg、20.45 cmH2O和65.28时,P(Aa)O2、CVP、IW三者联合预测患者撤机失败的灵敏度、特异度、AUC最高,分别为87.50%、92.55%和0.904。结论:重症颅脑损伤机械通气撤机失败患者撤机前P(Aa)O2、CVP过高,IWI过低,P(Aa)O2、CVP联合IWI对重症颅脑损伤机械通气患者撤机失败具有较理想的预测价值,可应用于临床。Objective:To explore the guiding significance of alveolar-arterial oxygen partial pressure difference[P(Aa)O2)]and central venous pressure(CVP)combined with comprehensive weaner index(IWI)in weaning from mechanical ventilation of patients with severe craniocerebral injury.Method:The clinical data of 118 mechanical ventilated patients with severe craniocerebral injury were retrospectively analyzed.The failure rate of ventilator weaning was statistically analyzed.The levels of P(Aa)O2,CVP and IWI before ventilator weaning were compared between the two groups of patients with successful and failed ventilator weaning.The predictive value of P(Aa)O2,CVP and IWI for the failure of ventilator weaning of patients with severe craniocerebral injury was analyzed.Result:Among the total 118 patients,24 were failed to wean from mechanical ventilation(20.34%).Both P(Aa)O2 and CVP in the successful weaning group were lower than those in the failed weaning group(P<0.05),and IWI in the successful weaning group was higher than that in the failed weaning group(P<0.05).When P(Aa)O2,CVP and IWI were at 22.12 mmHg,20.45 cmH2O and 65.28 respectively,the sensitivity,specificity and AUC of these three were the highest in predicting the failure of ventilator weaning,which were 87.50%,92.55%and 0.904,respectively.Conclusion:In patients with severe craniocerebral injury who failed to wean from mechanical ventilation,P(Aa)O2 and CVP were too high and IWI was too low.P(Aa)O2,CVP combined with IWI had good predictive value for the failure of ventilator weaning in patients with severe craniocerebral injury,and it could be applied in clinical practice.

关 键 词：肺泡-动脉氧分压差 中心静脉压 综合脱机指数 重症颅脑损伤 撤机 预测价值 

分 类 号：R651.15[医药卫生—外科学]