血管外肺水、容量参数等多因素与感染性休克患者撤机结局的Logistic回归分析  

Logistic regression analysis between the weaning outcome of patients with septic shock and EVLWI and ITBI

作　　者：黄伟平[1] 詹伟锋[1] 黄澄[1] 方明[1] 陈胜龙[1] 龙怡[1] 邓医宇[1] 蒋文新[1] 曾红科[1] 

机构地区：[1]广东省人民医院(广东省医学科学院)急危重症医学部,广州510080

出　　处：《中华急诊医学杂志》2014年第5期554-557,共4页Chinese Journal of Emergency Medicine

基　　金：广东省医学科研基金项目（C2011016,A2013020）;广东省科技计划项目（20108031600110）

摘　　要：目的探讨血管外肺水、容量参数等多因素对感染性休克患者撤机失败的风险。方法纳入2011年1月至2013年3月期间广东省人民医院收治的93例需上呼吸机的感染性休克患者，均在PiCCO监测下治疗，达到撤机标准后循序进行自主呼吸试验、撤机和拔管，根据48 h内撤机结局分为撤机成功组与撤机失败组。记录两组撤机前后各时间点（T0：撤机前；T1：撤机后1/2 h；T2：拔管后1/2 h）的血管外肺水指数（EVLWI）、肺血管渗透性指数（PVPI）、全心舒张末容积（GEDI），以及胸腔内血容量指数（ITBI）。用成组t检验和双因素重复测量方差分析撤机进程中两组间各参数的差别，用Logistic回归方法分析各因素对感染性休克撤机失败的风险。结果在T1、T2时两组的LG（ITBI）、LG（GEDI）和EVLWI均呈现增高趋势，相对撤机成功组，撤机失败组的LG（ITBI）、LG（GEDI）和EVLWI随撤机进程增加显著（P＜0.05）；Logistic回归分析显示EVLWI和ITBI是本组感染性休克患者撤机失败的危险因素（OR分别为10.89和6.65）。结论EVLWI、ITBI的变化与感染性休克患者撤离呼吸机结果的关系紧密，撤机过程中高水平的EVLWI、ITBI增加了撤机失败的风险。Objective To explore the values of extravascular lung water index （EVLW） and preload parameters in predicting the risk of weaning form mechanical ventilation in patients with septic shock. Methods A total of 93 septic-shock patients with mechanical ventilation were enrolled from January 2011 to March 2012 in Guangdong General Hospital. All patients were treated under PiCCO-monitoring till they reached weaning standards. After that, spontaneous breathing trial, weaning and extubation was performed in turn on patients. The patients were divided into two groups, including success group and failure group according to clinical outcome after weaning within 48 hours. EVLWI preload parameters such as global enddiastolie volume index （GEDI）, and intrathoracic blood volume index （ITBI） were examined at time points before and after weaning, including TO （before weaning） , T1 （1/2 h after weaning）, T2 （1/2 h after extubation）, respectively, t-test, ANOVA were carried out to analyze the difference in parameters between two groups, and logistic regression analysis was conducted to investigate the risk of factors mentioned above in weaning failure under septic-shock settings. Results At the time of T1 and T2, both groups showed the increasing trend of LG （ ITBI）, LG （GEDI） and EVLWI. Compared with the success group, the failure group had significantly higher level of EVLWI, GEDI and ITBI during weaning （ P 〈 0. 05 ）. Logistic regression analysis revealed that EVLWI and ITBI were risk factors for weaning failure from mechanical ventilation of patients with septic shock. Conclusion EVLWI and ITBI were correlated closely to weaning outcome of patients with sepsis shock after form mechanical ventilation. The high level of EVLWI and ITBI increased the risk of weaning during evacuating from mechanical ventilation.

关 键 词：感染性休克 机械通气 撤机 血管外肺水 容量参数 Logistics回归 全心舒张末容积 胸腔内血容量指数 

分 类 号：R459.7[医药卫生—急诊医学]