自主呼吸试验前后N端脑钠肽前体差值对非心源性危重症机械通气患者撤机结局的预测价值  

Predicting value of the difference between the NT-proBNP before and after the spontaneous breathing trial on weaning outcome of the non-cardiogenic critical illness patients with mechanical ventilation

作　　者：张秀珍 陈丽霞 梁伟华 谭光长 杨志鹏 陈样过 

机构地区：[1]广东省江门市新会区第二人民医院,广东江门529100

出　　处：《中国当代医药》2015年第23期25-27,30,共4页China Modern Medicine

基　　金：广东省江门市第八批科技计划项目(江科[2013]88号)

摘　　要：目的 探讨自主呼吸试验前后NT-proBNP差值对非心源性危重症机械通气患者撤机结局的预测价值。方法 选取2013年1月-2014年10月在本院内科ICU病房接受机械通气治疗的60例非心源性危重症患者作为研究对象,按照撤机结局分为成功组（n=49）和失败组（n=11）。采用受试者工作特征（ROC）曲线评价自主呼吸试验前后NT-proBNP差值预测撤机成功率的价值。结果 成功组自主呼吸试验后的NT-pro BNP水平显著低于失败组,差异有统计学意义（P〈0.01）。成功组自主呼吸试验前后的NT-proBNP差值显著低于失败组,差异有统计学意义（P〈0.01）。自主呼吸试验前后NT-proBNP差值预测撤机失败的ROC曲线下面积为0.935±0.035,以NT-proBNP上升581.5 pg/ml为拐点,预测撤机成功的灵敏度为90.9%,特异度为87.8%。结论 自主试验前后NT-proBNP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 explore the predicting value of the difference between the NT-pro BNP before and after the spontaneous breathing trial on weaning outcome of the non-cardiogenic critical illness patients with mechanical ventilation. Methods 60 non-cardiogenic critical illness patients with mechanical ventilation in the department of internal medicine in our hospital from January 2013 to December 2014 were selected and divided into the success group（n=49）and the failure group（n=11）according to the outcome of weaning.The value of NT-pro BNP difference in predicting the success rate of weaning was evaluated by using receiver operating characteristic（ROC） curve. Results The level of NT-pro BNP after the spontaneous breathing trial in the success group was lower than that in the failure group,with significant difference（P〈0.01）.The difference value between the NT-pro BNP before and after the spontaneous breathing trial in the success group was lower than that in the failure group,with significant difference（P〈0.01）.The area under cure（AUC） of the ROC cure of NT-pro BNP difference before and after the spontaneous breathing trial to predict the failure of weaning was 0. 935±0.035,the cut-off level of NT-pro BNP was 581.5 pg/ml and the sensitivity was 90.9%,specificity was84.7%.Conclusion The change of NT-pro BNP before and after the spontaneous breathing trial can be used as one of the screening indicators for weaning,combined with spontaneous breathing trial can raise the successful rate ofweaning.

关 键 词：N端脑钠肽前体 自主呼吸试验 受试者工作特征曲线 撤机 

分 类 号：R459.9[医药卫生—治疗学]