决策树模型预测综合ICU机械通气患者拔管结果的价值  

Decision-making Tree Predicting Extubation Outcomes in Patients with Comprehensive ICU Mechanical Ventilation

作　　者：刘阳[1] 魏路清[1] 李国强[1] 于鑫[1] 李国峰[1] 

机构地区：[1]武警后勤学院附属医院呼吸与重症医学科,天津市300161

出　　处：《中国全科医学》2014年第35期4170-4174,共5页Chinese General Practice

摘　　要：目的通过决策树算法整合多个临床常用指标,形成决策树模型,探讨决策树模型预测综合ICU机械通气患者拔管结果的价值。方法选取2008年12月—2012年12月武警后勤学院附属医院综合ICU收治的气管插管机械通气时间超过48 h的患者571例,对患者进行自主呼吸试验(SBT),由主治医生判断患者是否耐受SBT。将SBT成功的患者分别纳入拔管成功(ES)组和拔管失败(EF)组。记录两组患者一般资料及在SBT开始后1、30、60 min测量患者呼吸浅快指数(RSBI)、分钟通气量(VE)、口腔阻断压(P0.1)、P0.1×RSBI和SBT 30 min时RSBI变化率(ΔRSBI30)。结果 SBT成功者451例,其中ES组376例,EF组75例。两组患者年龄、平均动脉压、急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)比较,差异均无统计学意义(P>0.05)。ES组心率、机械通气时间低于EF组(P<0.05)。组间比较显示,SBT开始后1、30、60 min ES组RSBI、P0.1、P0.1×RSBI均低于EF组(P<0.001);SBT开始后1、30、60 min两组VE比较,差异无统计学意义(P>0.05)。组内比较显示:ES组RSBI、P0.1×RSBI在SBT开始后30、60 min均低于SBT开始后1 min,VE、P0.1在SBT开始后30、60 min均高于SBT开始后1 min(P<0.05);EF组RSBI、VE、P0.1、P0.1×RSBI在SBT开始后30、60 min均高于SBT开始后1 min(P<0.05)。ES组ΔRSBI30为(98±36)%,低于EF组的(130±63)%(t=-6.200,P<0.001)。各生理学参数预测ES准确性比较,差异有统计学意义(χ2=53.4,P<0.05)。以P0.1×RSBI30≤384 cm H2O·次·min-1·L-1预测ES的ROC曲线下面积(AUC)为(0.87±0.03),与AUC=0.5比较,差异有统计学意义(z=13.8,P<0.001)。CRT分析选择P0.1×RSBI30、ΔRSBI30作为解释变量对患者进行分类,决策树的目标变量为ES。决策树模型预测ES的灵敏度为100.0%,特异度为81.3%,阳性预测值为96.4%,阴性预测值为100.0%,准确性为96.8%,AUC为(0.91±0.02),与AUC=0.5比较,差异有统计学意义〔95%CI(0.88,0.93),z=17.96,P<0.001〕。决策树模型预测ES的AUC和准确性均高Objective To explore the values of decision-making tree（ DMT） in prediction of the extubation outcomes of patients with comprehensive ICU mechanical ventilation. Methods From December 2008 to December 2012,in Department of Respiratory and Critical Care Medicine of Affiliated Hospital of Armed Police Logistics Institute,571 patients who had intubation and mechanical ventilation for more than 48 h underwent spontaneous breathing trial（ SBT）. The attending doctors judged whether patients tolerated SBT. The patients who had successful SBT were divided into extubation success（ ES） group,those who failed in SBT divided into extubation failing（ EF） group. The general information was recorded, rapid shallow breathing index（ RSBI）,minute ventilation（ VE）,mouth occlusion pressure（ P0. 1）,P0. 1× RSBI were measured at minutes1,30,60 after SBI,RSBI change rate at SBT 30 min（ ΔRSBI30）. Results A total of 451 patients were enrolled,376 in ES group,75 in EF group. There was no significant difference in age,mean arterial pressure,APACHE Ⅱ score between the 2groups（ P〉0. 05）. The heart rate was lower,mechanical ventilation time shorter in ES group than in EF group,the difference was significant（ P〈0. 05）. In group comparison,RSBI,P0. 1,P0. 1× RSBI were lower in ES group than in EF group at mi-nutes 1,30,60 after SBT starting（ P〈0. 001）,there was no difference in VE between the 2 groups（ P〈0. 05）. In intra-group comparison in ES group,RSBI,P0. 1× RSBI were lower,VE,P0. 1higher at minutes 30,60 than at minute 1 after SBT,the difference was significant（ P〈0. 05）; in EF group,RSBI,VE,P0. 1,P0. 1× RSBI were higher at minutes 30,60 than at minute 1（ P〈0. 05）. ΔRSBI30of ES group was（ 98 ± 36） %,lower than that of EF group（ 130 ± 63） %（ t =-6. 200,P〈0. 001）. There was difference in accuracy of physiological parameters predicting ES（ χ^2= 53. 4,P〈0. 05）. P0. 1× RSBI30≤384 cm H12O·breaths·min^-1· L^-1 AUC was（ 0. 87 ± 0. 03）,differe

关 键 词：决策树 机械通气 ROC曲线 拔管 口腔阻断压 

分 类 号：R56[医药卫生—呼吸系统]