小儿呼吸机撤机的影响因素及撤机指标预测价值分析  

Factors influencing ventilator weaning and predictive value of weaning criteria in children

作　　者：苏小燕[1] 何颜霞[2] 

机构地区：[1]惠州市中心人民医院儿童重症医学科,516001 [2]汕头大学医学院深圳市儿童医院重症医学科,518026

出　　处：《中华儿科杂志》2014年第10期783-787,共5页Chinese Journal of Pediatrics

摘　　要：目的 探讨小儿呼吸机撤机的影响因素并分析同步间歇指令通气＋压力支持（SIMV＋ PSV）和自主呼吸试验（SBT）两种撤机模式下各撤机指标的预测价值.方法 选择2012年4月至2013年10月深圳市儿童医院收治的机械通气超过24 h的患儿132例,根据临床经验使用SIMV＋PSV、SBT两种撤机模式,分析患儿年龄、性别、体重、危重评分、机械通气时间、入住PICU时间及导致机械通气的病因对撤机的影响,用ROC曲线下面积评估氧合指数（PaO2/FiO2）、潮气量（Vt/kg）、顺应性（Cst）、浅快呼吸指数（RSBI）、RSBI的变化趋势[ΔRSBI=（RSBI2-RSBI1）/RSBI1,其中RSBI1、RSBI2分别为SBT开始和结束时的RSBI]对撤机成功与否的预测价值.结果 132例患儿,成功109例,失败23例.其中SIMV＋ PSV撤机模式79例（59.8％）,成功64例,失败15例,撤机成功率为81.0％.SBT撤机模式53例（40.2％）,成功45例,失败8例,撤机成功率为84.9％.两种撤机模式的撤机成功率差异无统计学意义（x2 =0.334,P=0.563）.患儿年龄、性别、体重、危重评分在撤机成功组和失败组之间差异无统计学意义（t=-0.661,x2=1.271,t=-0.749、-0.020,P均＞0.05）.机械通气时间、入住PICU时间及导致机械通气的病因在两组中的差异有统计学意义（t=3.751、3.701,x2=11.273,P＜0.05）.SIMV＋ PSV撤机模式下PaO2/FiO2、Vt/kg、Cst及RSBI的ROC曲线下面积分别为0.506、0.415、0.557、0.512,SBT撤机模式下分别为0.503、0.653、0.546、0.708.两种撤机模式下,以上指标的ROC曲线下面积差异均无统计学意义（P＞0.05）.SBT撤机模式下ΔRSBIAUC为0.814,与SIMV＋ PSV撤机模式下RSBI AUC（0.512）相比,差异有统计学意义（Z =2.966,P＜0.05）.结论 机械通气时间超过24h的患儿,撤机的主要影响因素为机械通气时间、入住PICU时间及导致机械通气的病因.撤机指标ΔRSBI对小儿撤机的预测价值较高,具备可行性及安全性,可在临床推广.Objective To analyze the factors that influence the outcome of ventilator weaning and the predictive value of ventilator weaning criteria such as PaO2/FiO2,Vt/kg,Cst,RSBI and the changing trend of RSBI [ΔRSBI =（RSBI2-RSBI1）/ RSBI1,RSBI1 and RSBI2 are the start and end of SBT separately] in children.Method One hundred and thirty-two children who were mechanically ventilated over 24 hours were enrolled from April 2012 to October 2013 in Shenzhen Children＇s Hospital.SIMV ＋ PSV and SBT ventilator mode were used in ventilator weaning according to clinical experience.Age,gender,weight,critical illness score,duration of mechanical ventilation,PICU stays and the causes to mechanical ventilation were taken into account as the effect on the result of ventilator weaning.Using area under ROC curve of the indexes such as PaO2/FiO2,Vt/kg,Cst,RSBI and the ΔRSBI to evaluate the predictability of children ventilator weaning.Result One hundred and thirty-two children were enrolled and 109 succeeded in ventilator weaning,while 23 failed.Seventy-nine children using SIMV ＋ PSV mode and 64 succeeded in ventilator weaning among them,while 23 failed.The success rate was 81.0%.The remaining 53 children using SBT mode,45 among them succeeded and 8 failed in ventilator weaning,which success rate was 84.9%.There was no statistically significant difference in ventilator weaning mode （x2 =0.334,P =0.563）.Age,gender,weight,critical illness score between the succeeded group and the failed group did not show statistically significant difference （t =-0.661 ; x2 =1.271 ; t =-0.749,-0.020 ; P 〉 0.05）,but duration of mechanical ventilation,PICU stays and the causes for mechanical ventilation showed significant difference （t =3.751,3.701 ; x2 =11.273,P 〈 0.05）.The area under ROC curve of PaO2/FiO2,Vt/kg,Cst and RSBI in SIMV ＋ PSV was 0.506,0.415,0.557 and 0.512,in SBT was 0.503,0.653,0.546 and 0.708 separately.There was no statistically significant difference in the predictors mentioned above（P 〉0.05）.But the area

关 键 词：呼吸 人工 曲线下面积 影响因素 预测 

分 类 号：R725[医药卫生—儿科]