呼吸浅快指数对机械通气新生儿呼吸机撤离预测准确性的影响  

Impact of rapid shallow breathing index on predictive accuracy of weaning from ventilator in neonate with mechanical ventilation

作　　者：马荣伟[1] 王莉[2] 刘克战[3] 吴凡[3] 李颖[4] 张向荣 Ma Rongwei;Wang Li;Liu Kezhan;Wu Fan;Li Ying;Zhang Xiangrong(Department of NICU,Shanxi Provincial Children＇s Hospital,Taiyuan 03013,China)

机构地区：[1]山西省儿童医院新生儿重症科,太原030013 [2]山西省儿童医院医保科,太原030013 [3]山西省儿童医院新生儿科,太原030013 [4]山西省儿童医院护理部,太原030013

出　　处：《中国药物与临床》2018年第7期1081-1084,共4页Chinese Remedies & Clinics

基　　金：山西省软科学研究一般项目(2017041041-2)

摘　　要：目的寻找新生儿呼吸机撤机的影响因素并分析自主呼吸实验(SBT)过程中预测拔管成功的呼吸参数。方法选取2015年9月至2017年12月山西省儿童医院新生儿重症监护病房(NICU)收治的机械通气时间超过24 h的符合撤机准入标准的100例患儿进行60 min的SBT;分析患儿胎龄、性别、出生体质量、机械通气时间、入住NICU时间、导致机械通气的病因及撤机前后30 min血气分析对撤机的影响;SBT下记录1、30、60 min时患儿的自主呼吸潮气量(VT)、呼吸频率(RR),计算呼吸浅快指数(RSBI)及各点的变化量,比较拔管成功组和拔管失败组的临床资料和SBT过程中各呼吸参数,ROC曲线下面积(AUC)评估各呼吸参数对成功拔管的预测的准确性。结果 100例患儿,成功85例,失败15例,撤机成功率85%。患儿性别、胎龄、出生体质量、撤机前后30 min血气分析在撤机成功组和失败组之间差异无统计学意义(P>0.05);机械通气时间、入住NICU时间及导致机械通气的病因在拔管成功组和失败组的差异有统计学意义(t=-6.785,-6.163;χ~2=9.283,P<0.05)。在拔管成功组,SBT开始后随着时间延长RSBI呈现逐渐减少趋势,而在拔管失败组,RSBI则持续增加,RSBI30、RSBI60在拔管成功组和失败组差异有统计学意义(4.5±0.6,5.4±1.0,P=0.046;3.7±1.2,5.8±0.6,P=0.000),RSBI1、RSBI30、RSBI60的AUC分别为0.626、0.645、0.733;RSBI30、RSBI60敏感度、特异度分别为(66.5%、75.9%;78.4%、90.1%)。结论在SBT过程中各项呼吸参数都很重要,RSBI30、RSBI60对于拔管成功有预测价值,RSBI60趋于逐渐降低,拔管成功率越高。Objective To determine the influencing factors for weaning from ventilator among newborns, and to analyze the respiratory indexes that predict the extubation success during the spontaneous breathing trial（SBT）.Methods A total of 100 children, who were hospitalized in the NICU, Shanxi Provincial Children′s Hospital between September 2015 and December 2017 with a mechanical ventilation of more than 24 hours, were included in the study. Sixty min of SBT was performed in all patients who fulfilled the inclusion criteria of weaning from ventilator. The impacts of gestational age, gender, birth weight, mechanical ventilation time, length of stay at NICU, etiology of mechanical ventilation and blood gas analysis at 30 min before and after the weaning were analyzed. The tidal volume of spontaneous breath and respiratory rate（RR） at 1, 30 and 60 min of SBT were recorded, and the rapid shallow breathing index（RSBI） and the changes at different time points were calculated. The clinical data and the indexes during SBT were compared between the successful extubation group and unsuccessful extubation group. The area under the receiver operating characteristic（ROC） curve（AUC） was used to assess the predictive accuracy of the respiratory indexes for successful extubation. Results In the 100 cases, 85 were successful and 15 were unsuccessful, and the success rate of weaning was 85%. There were no statistically significant differences in the gender,gestational age, birth weight, and blood gas analysis at 30 min before and after the weaning between the successful extubation group and unsuccessful extubation group（all P〉0.05）. There were statistically significant differences in the mechanical ventilation time, length of stay at NICU, and etiology of mechanical ventilation between the successful extubation group and unsuccessful extubation group（t=-6.785 and-6.163, χ~2=9.283,P〈0.05）. In the successful extubation group, RSBI showed a decreasing trend over time after the SBT, while the RSBI continued

关 键 词：呼吸浅快指数 呼吸功能试验 

分 类 号：R722.1[医药卫生—儿科]