累积液体平衡在ICU危重患者拔管结局中的预测价值  

Predictive value of the cumulative fluid balance for the extubation outcome of ICU patients

作　　者：颜瑶[1] 徐进步[1] 刘璐 王小娟 YanYao;Xu Jin-bu;Liu Lu;Wang Xiao-juan(Department of Intensive Care Unit,the Second People′s Hospital of Lianyungang,Lianyungang 222023,China)

机构地区：[1]连云港市第二人民医院重症医学科,江苏连云港222023

出　　处：《中国急救医学》2020年第5期422-426,共5页Chinese Journal of Critical Care Medicine

基　　金：连云港市卫健委科研课题计划项目(QN1808)。

摘　　要：目的探讨累积液体平衡在重症医学科(ICU)危重患者拔管结局中的预测价值。方法回顾性分析2016年1月至2019年5月收住于连云港市第二人民医院ICU的接受有创机械通气超过24 h并在成功自主呼吸试验(SBT)后拔管的200例危重患者的临床病例资料。应用《机械通气临床应用指南(2006)》标准进行有创通气的撤机,并根据拔管结果分为拔管成功组(n=166)和拔管失败组(n=34),比较两组患者拔管前的累积液体平衡水平,采用受试者工作特征(ROC)曲线评价其对ICU危重患者拔管结局的预测价值。结果拔管失败组累积液体平衡水平[中位数(IQR)1710.00(2.50~4136.25)mL]显著高于拔管成功组[IQR 617.50(-694.00~2066.25)mL,P=0.030]。通过ROC分析得出,预测ICU危重患者拔管失败的累积液体平衡水平的最佳截点值为1505 mL(敏感度67.6%,特异度67.5%),其ROC曲线下面积(AUC)为0.703[95%可信区间(CI)0.598~0.809]。通过单因素分析得出,与拔管失败相关的其他危险因素是年龄、机械通气的持续时间、慢性肾病和慢性神经系统疾病、拔管时的心率和呼吸频率。在Logistic回归模型中,累积液体平衡>1505 mL具有预测ICU危重患者拔管失败的能力[优势比(OR)3.465,95%CI 1.261~9.518]。结论拔管前累积液体平衡水平与ICU危重患者拔管结局显著相关。当累积液体平衡>1505 mL时,ICU危重患者有着更高的拔管失败风险。Objective To investigate the predictive value of the cumulative fluid balance for the extubation outcome of ICU patients.Methods Clinical data of 200 ICU patients admitted to the Second People′s Hospital in Lianyungang from January 2016 to May 2019,who were mechanically ventilated for at least 24 h and then extubated after successful spontaneous breathing trial,were retrospectively analyzed.Based on the extubating standards of guidelines for clinical application of mechanical ventilation(2006),the subjects were divided into two groups:the successful extubation group(n=166)and the unsuccessful extubation group(n=34).The cumulative fluid balance of the two groups were compared before extubation,and the predictive value was evaluated by the receiver operating characteristic(ROC)curve.Results The level of the cumulative fluid balance in the unsuccessful extubation group[IQR 1710.00(2.50-4136.25)mL]was significantly higher than that in the successful extubation group[IQR 617.50(-694.00-2066.25)mL,P=0.030].The optimal cutoff of the cumulative fluid balance for extubation failure was 1505 mL(sensitivity 67.6%,specificity 67.5%)by ROC curve analysis,and the area under the curve(AUC)was 0.703[95%confidence interval(CI)0.598-0.809].Other risk factors for extubation failure identified by univariate analysis were the age,the duration of mechanical ventilation,chronic kidney disease,neurological disease,and the rate of heart and breathing at the moment of extubation.In Logistic regression model,the cumulative fluid balance>1505 mL retained its predictive potential for extubation failure(odds ratio=3.465,95%CI 1.261-9.518).Conclusion The cumulative fluid balance before extubation was significantly associated with the extubation outcome.The cumulative fluid balance>1505 mL predicted a higher risk of extubation failure in ICU patients.

关 键 词：液体平衡 危重患者 拔管 预测价值 

分 类 号：R459.7[医药卫生—急诊医学]