自主呼吸试验联合B型脑钠肽浓度预测撤机成功率的价值  

B-Type Natriuretic Peptide Improve Weaning Outcome Predicted by Spontaneous Breathing Trial

作　　者：杨田军[1] 张德文[1] 吕世进[1] 王锦全[1] 刘宝[1] 

机构地区：[1]安徽省立医院ICU,安徽合肥230001

出　　处：《中国呼吸与危重监护杂志》2011年第6期590-593,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的评价自主呼吸试验联合试验前后B型脑钠肽(BNP)变化情况是否能提高撤机成功率。方法前瞻性队列研究,收集2008年7月至2010年12月安徽省立医院83例ICU住院需机械通气患者自主呼吸试验前30 min及90 min自主呼吸试验结束时血浆BNP数据。依撤机结局将患者分为成功组和失败组。正态分布数据采用t检验,非正态分布数据采用非参数独立样本及配对检验。用受试者工作特征(ROC)曲线评价自主呼吸试验前后BNP差值预测撤机成功率的价值。结果 83例患者中,撤机失败13例(15.7%)。6例自主呼吸试验成功而撤机失败(占入选患者的7.2%,占撤机失败患者的46.2%)。自主呼吸试验结束时BNP水平显著高于试验前。撤机成功组自主呼吸试验结束时BNP水平及上升幅度均明显小于撤机失败组(P<0.001)。自主呼吸试验前后BNP差值预测撤机失败的ROC曲线下面积为0.94±0.03(P<0.001),以BNP上升123 pg/mL为拐点,预测撤机成功的敏感性为92.3%,特异性为91.4%。结论自主试验前后BNP的变化可作为撤机结局的一种预测指标,联合自主呼吸试验能提高撤机的成功率。Objective To determine whether B-type natriuretic peptide（BNP） levels combined with spontaneous breathing trial（SBT） could improve the weaning outcome.Methods Eighty-three patients who were ready to undergo a 90-minute weaning trial（low-pressure support level） were enrolled.Weaning was considered to be successful if the patient passed the trial and sustained spontaneous breathing for more than 48 h after extubation.Plasma BNP was measured just before and at the end of the trial.All patients were divided into a weaning success group and a weaning failure group according to the outcomes of weaning.Categorical variables,expressed as percentages,were analyzed with a chi-square test or a Fisher′s exact test.Continuous variables were expressed as median（25th-75th percentile） and were compared using the Wilcoxon paired test（for related samples） or the Kolgomorov-Smirnov test（for independent samples）.A two-tailed p value of less than 0.05 was taken to indicate statistical significance.Receiver operating characteristic（ROC） curve analysis was performed to assess plasma BNP′s ability to discriminate the subjects who weaned succesfully or failed.Results Overall,13 patients（16.7%） failed the weaning process（6 patients passed the trial but failed extubation）.At the end of SBT,the BNP levels of the weaning failure group were significantly higher than the weaning success group.The BNP levels of the weaning failure group were significantly higher than the weaning success group（P0.001）.The area under cure（AUC） of the ROC curve of BNP to predict the failure of weaning was 0.94±0.03（P0.001）.At a cut-off level of 123 pg/mL,BNP had a predictive efficiency in weaning outcome as Yourdon′s index of 0.837,sensitivity of 92.3%,and specificity of 91.4%.Conclusion Monitoring the change of BNP during a SBT may improve weaning outcome.

关 键 词：B型脑钠肽 自主呼吸试验 受试者工作特征曲线 撤机 

分 类 号：R459.7[医药卫生—急诊医学]