压力支持和T管自主呼吸试验对拔管结局预判准确性的比较研究  

Comparison of the predictive accuracy of extubation outcomes between pressure support and T-piece SBT as screening tests

作　　者：沈剑[1] 王振艳 马航 刘芳[1] 封喜翠 袁宏勋[1] SHEN Jian;WANG Zhenyan;MA Hang;LIU Fang;FENG Xicui;YUAN Hongxun(Department of Critical Care Medicine,Peking University International Hospital,Beijing,102206,China)

机构地区：[1]北京大学国际医院重症医学科,北京102206

出　　处：《临床急诊杂志》2020年第4期296-300,共5页Journal of Clinical Emergency

摘　　要：目的:比较压力支持自主呼吸试验(PS-SBT)和T管自主呼吸试验(T-SBT)对机械通气患者拔管结局预判能力的差异。方法:在标准程序化脱机流程中,使用自身前后对照方法,对114例入选的机械通气患者分别进行PS-SBT和T-SBT试验,以拔管结局作为金标准,比较其在拔管结局预测上的敏感度和特异度的差异。结果:PS-SBT的通过率明显高于T-SBT(92.1%vs. 77.2%),敏感度、特异度、诊断准确度和约登指数,PS-SBT分别为96.8%、28.6%、84.2%和0.254,T-SBT分别为86.0%、61.9%、81.6%和0.479。敏感度PS-SBT占优,特异度T-SBT占优。结论:拔管前应合理分析过早拔管和延迟拔管分别对患者产生的利弊,再决定筛选试验是选择敏感度高的PS-SBT还是特异度高的T-SBT。Objective: To compare the predictive ability of pressure support(PS-SBT) and T-piece(T-SBT) spontaneous breathing test in predicting the outcome of extubation in patients undergoing mechanical ventilation. Method: In the standard programmed weaning process, the PS-SBT and T-SBT trials were performed on 114 patients undergoing mechanical ventilation using before and after control method, taking the extubation outcome as the gold standard and comparing the differences in sensitivity and specificity in prediction of extubation outcome. Result: The passing rate of PS-SBT was significantly higher than that of T-SBT(92.1% vs. 77.2%). The sensitivity, specificity, accuracy and the Youden index of PS-SBT were 96.8%, 28.6%, 84.2% and 0.254, respectively, that of T-SBT were 86.0%, 61.9%, 81.6%, and 0.479, respectively. The sensitivity of PS-SBT is dominant, and the specificity of T-SBT is dominan. Conclusion: Before extubation, reasonably analyze the pros and cons of the impact of premature and delayed extubation on patients, and then decide whether the screening test should choose a highly sensitive PS-SBT or a highly specific T-SBT.

关 键 词：自主呼吸试验 机械通气 气管插管拔管 程序化脱机 拔管失败 

分 类 号：R563.8[医药卫生—呼吸系统]