气道闭合压、最大吸气压和呼吸浅快指数对慢阻肺患者撤机的预测价值  

Predictive value of airway closure pressure,maximal inspiratory pressure and shallow breathing fast index on ventilator withdraw in patients with COPD

作　　者：林传焕 刘毅君[1] 谷欣[1] 

机构地区：[1]惠州市第三人民医院重症医学科,广东惠州516000

出　　处：《临床肺科杂志》2016年第12期2240-2243,共4页Journal of Clinical Pulmonary Medicine

基　　金：惠州市科技计划项目(No 2015Y137)

摘　　要：目的针对气道闭合压、最大吸气压和呼吸浅快指数对慢阻肺患者撤机的预测价值进行研究。方法随机选择2013年12月-2015年12月期间,医院收治的慢性阻塞性肺疾病(慢阻肺)患者80例,作为本次研究的对象,对患者实施气道闭合压、最大吸气压和呼吸浅快指数等的检测,并根据患者撤机成功与否,比较撤机成功与撤机失败患者的撤机参数。结果在本次研究中慢阻肺患者的进口气管插管机械通气治疗中,患者撤机成功人数为53例,撤机失败人数27例。撤机成功组患者的气道闭合压(P0.1)、最大吸气压(Pi max)和呼吸浅快指数(RSBI)与撤机失败组患者的各项撤机指标进行比较,P<0.05,具有统计学意义。慢阻肺患者的撤机指标的预测价值进行分析,气道闭合压(P0.1)的灵敏度最高,为90%,其次是最大吸气压(Pi max)为85%,呼吸浅快指数(RSBI)64%。气道闭合压(P0.1)的特异性最高为76%,其次是呼吸浅快指数(RSBI)的特异性,为57%,最后是最大吸气压(Pi max)为45%。而三种指标的准确率分别为87%、73%、62%,综合分析得出,气道闭合压(P0.1)的预测价值最高,其次是最大吸气压(Pi max)和呼吸浅快指数(RSBI)。结论在慢阻肺患者的撤机中,气道闭合压、最大吸气压可以作为患者的撤机预测指标,呼吸浅快指数也可以在撤机预测中起到一定的作用。Objective To research the predictive value d airway closure pressure, maximal inspiratory pres- sure and shallow breathing fast index on ventilator withdraw in patients with COPD. Methods 80 COPD patients were randomly selected from Deeember 2013 to December 2015, their airway closure pressure, maximal inspiratory pressure and shallow breathing fast index were detected. According to the patients withdrawing ventilator successfully or not, the related parametem were compared. Results For the COPD patients received import endotraeheal intuba- tion mechanical ventilation, 53 eases succeeded ventilator withdraw, and 27 cases failed. There were significant differenees in airway closure pressure （ P0. 1 ）, maximal inspiratory pressure （ Pi Max） and shallow breathing fast in- dex （RSBI） between the success group and the failure group （ P 〈 0. 05 ）. The predicted value of airway closure pressure （PO. 1 ） had the highest sensitivity of 90%, followed by the maximal inspiratory pressure （Pi Max） of 85%, and shallow breathing fast index （ RSBI ） of 64%. Airway closure pressure （ P0. 1 ） had the highest specificity （76%）, and followed by shallow breathing fast index （RSBI） （ 57% ）, and maximal inspiratory pressure （Pi） （45%）. The accuracy of the three indicators was 87%, 73% and 87% respectively. Through comprehensive analy- sis, the predictive value of airway closure pressure （P0. 1 ） was highest, and the second was the maximal inspiratory pressure （Pi Max） and shallow breathing fast index （RSBI）. Conclusion In COPD patients needing ventilator withdraw, airway closure pressure and maximal inspiratory pressure have certain guidance value on withdraw, and shallow breathing fast index also plays a role in the ventilator prediction.

关 键 词：慢阻肺 气道闭合压 最大吸气压 呼吸浅快指数 撤机预测 

分 类 号：R563.9[医药卫生—呼吸系统]