动态能量消耗监测指导机械通气患者撤机有效性的临床研究  

Clinical study on the predictive value of dynamic energy expenditure monitoring to guide the weaning from mechanical ventilation

作　　者：钱雅君 刘洋[1] 郝迎迎[1] 陈鸣[1] 顾勤[1] 董丹江[1] QIAN Yajun;LIU Yang;HAO Yingying;CHEN Ming;GU Qin;DONG Danjiang(Department of Intensive Care Medicine,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing,Jiangsu 210009,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院重症医学科,江苏南京210009

出　　处：《中国呼吸与危重监护杂志》2021年第5期325-329,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：南京市医学科技发展一般项目(YKK17071)。

摘　　要：目的在达到撤机标准并接受序贯降低呼吸机参数的机械通气患者中,比较动态监测能量消耗(EE)的方法与传统方法(呼吸浅快指数)对于撤机成功率的预测性。方法研究共纳入2018至2019年度重症医学科收治的共93例机械通气并符合撤机指征的患者,使用GE呼吸机(CARESCAPE R860)的能量代谢监测装置,通过间接测热法记录患者在呼吸机参数递降过程中,各时相[T1(PSV 20/5),T2(PSV 15/5),T3(PSV 10-5/5),T4(PSV 5/5)]EE的变化率(δEE,%),比较撤机成功组及失败组两组患者间不同时相δEE是否存在显著差异。并通过受试者工作特征(ROC)曲线分析δEE对撤机成功率的预测价值。结果共有36例患者撤机失败。成功组和失败组患者的基础状态、疾病类型无显著差异。两组患者在T1至T2时相的δEE1无显著差异[(5.67±2.31)%比(6.40±1.90)%,P>0.05],但T2至T3及T3至T4时相的δEE存在显著差异[δEE2:(11.35±5.39)%比(14.21±6.33)%,P<0.05;δEE3:(8.39±3.90)%比(17.32±9.07)%,P<0.05]。δEE2、δEE3对患者撤机结果预测的ROC曲线下面积均高于呼吸浅快指数[0.83和0.75比0.64,P<0.05]。结论动态EE监测能有效评估及预测机械通气撤离的成功率,可在临床上应用于指导撤机过程。Objective To compare the predictive values of dynamic energy expenditure(EE) monitoring and the traditional method(rapid shallow breath index) for weaning in patient who is suitable for weaning from mechanical ventilation and accepts sequentially reduced support of ventilator. Methods This study included a total of 93 patients who were admitted to the Department of Intensive Care Medicine in 2018 to 2019, and were eligible for weaning from mechanical ventilation. The energy expenditure monitoring device of GE ventilator(CARESCAPE R860) was used to record the patient’s change rate of EE [δEE(%), T1(PSV 20/5), T2(PSV 15/5), T3(PSV 10-5/5), T4(PSV 5/5)] while the ventilation support was declined. The differences in δEE were compared between the two groups of patients who were successful weaned(a successful group S) or failed(a failed group) at different phases. The receiver operator characteristic(ROC) curve was used to analyze the predictive value of δEE to the success rate of weaning. Result A total of 36 patients failed weaning procedure. There was no significant difference in the basic status and disease type between the successful group and the failed group. There was no difference in δEE1 between T1-T2 phases [(5.67±2.31)% vs.(6.40±1.90)%,P>0.05], but significant difference in δEE between T2-T3 and T3-T4 phases [δEE2:(11.35±5.39)% vs.(14.21±6.33)%,P<0.05;δEE3:(8.39±3.90)% vs.(17.32±9.07)%, P<0.05]. The area under the ROC curve predicted by δEE2 and δEE3 for the patient’s weaning results was higher than rapid shallow breath index(0.83 and 0.75 vs. 0.64, P<0.05). Conclusion Dynamic energy expenditure monitoring can effectively evaluate and predict the success rate of weaning from mechanical ventilation, and can be applied to the clinical treatment process.

关 键 词：能量消耗 机械通气 撤机 呼吸浅快指数 

分 类 号：R459.7[医药卫生—急诊医学]