N末端B型脑钠肽和呼吸用力指数在心力衰竭患者机械通气撤机中的预测价值  

Prediction value of NT-proBNP level and CORE index for weaning of mechanical ventilation in patients with heart failure

作　　者：林惠文[1] 陈荣健[1] 区秀凤[1] 

机构地区：[1]广东省江门市中心医院急诊科,529070

出　　处：《中国实用医药》2014年第26期3-6,共4页China Practical Medicine

摘　　要：目的探讨N末端B型脑钠肽(NT-proBNP)和呼吸用力(CORE)指数对心力衰竭(HF)患者机械通气撤机的预测价值。方法对46例机械通气时间>72 h的HF患者进行回顾性分析,当患者达到撤机条件行自主呼吸试验(SBT)前,抽血检测血浆NT-proBNP水平和动脉血气分析,并记录脱机参数,包括呼吸频率(f),动态顺应性(Cdyn),气道闭合压(P0.1),最大吸气压(PImax)等,计算CORE指数。根据撤机结局,将患者分为成功组和失败组,比较两组性别、年龄、撤机前急性生理与慢性健康评分(APACHE II评分)、NT-proBNP水平和CORE指数的差异。结果通过SBT试验的46例患者中,撤机成功有33例(71.74%)。两组性别、年龄和APACHE II评分差异均无统计学意义(P>0.05);成功组NT-proBNP值相对较低,CORE指数则相对较高(P<0.01)。以NT-proBNP和CORE指数为协变量,利用logistic模型对撤机结果进行预测,总准确率为93.48%(43/46),明显高于SBT试验的准确率(71.74%,P<0.05)。NTproBNP预测撤机成功的ROC曲线下面积(AUC)为0.88(95%可信区间为0.78~0.98,P<0.05),撤机成功的截点值为1372.73 pg/ml;CORE指数的AUC为0.94(95%可信区间为0.86~1.00,P<0.05),撤机成功的截点值为5.95。结论 NT-proBNP下降至1372.73 pg/ml,CORE指数上升至5.95,对于HF患者能成功撤离机械通气的预测价值较高,可作为撤机筛查指标。Objective To investigate the prediction value of N-terminal pro-brain natriuretic peptide （NT-proBNP） level and the compliance, oxygenation, respiration and effort （CORE） index for weaning of mechanical ventilation in patients with heart failure （HF）. Methods A retrospective analysis was made with 46 HF patients with mechanical ventilation for more than 72 hours. When patients reached weaning criteria, before spontaneous breathing trials （SBT）, plasma levels of NT-proBNP and blood gas analyses using arterial blood were measured, whilst weaning indexes, such as breathing rate （f）, Lung dynamic compliance （Cdyn）, Airway occlusion pressure （P0.1）, Maximal inspiratory pressure （P^r~）, were recorded for calculation of CORE index. Based on weaning outcomes, all the patients were divided into success group and failure group, between which the age, gender, acute physiology and chronic health score （APACHE II）, NT-proBNP levels and CORE indexes were compared. Results There were 46 cases passed the SBT test, and the weaning success rate was 71.74%. There were no statistical significance in the differences of age, gender and APACHE II score between the two groups （P〉0.05）. Lower levels of NT-proBNP and higher CORE indexes were observed in success group （P〈0.01）. With two covariates of NT-proBNP and CORE index, the total predicted percentage of correction was 93.48% （43/46） by logistic equation, which was significantly higher than that predicted by SBT （71.74%, P〈0.05）. The area under ROC curve （AUC） of NT-proBNP predicting successful weaning was 0.88 （95% CI 0.78-0.98; P〈0.05） with a cutoff point of 1372.73 pg/ml. The AUC of CORE index was 0.94 （95% CI 0.86-1.00; P〈0.05） with a cutoff point of 5.95. Conclusion Both NT-proBNP （〈1372.73 pg/ml） and the CORE index （〉5.95） were accurate indicators as predictors for successful weaning.

关 键 词：N末端B型脑钠肽 呼吸用力指数 心力衰竭 机械通气 撤机 

分 类 号：R541.6[医药卫生—心血管疾病]