超声心排血量监测联合被动抬腿试验在老年机械通气患者中撤机成功的预测价值  

Predictive value of ultrasonic cardiac output monitoring with passive leg raising test for the successful extubation outcome of elderly ventilated patients

作　　者：熊蜀佩 郑春 张永 XIONG Shu-pei;ZHENG Chun;ZHANG Yong(Department of Respiratory and Critical Medicine,the Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China;Department of Criical Care Medicine,the First People’s Hospital of Neijiang,Neijiang,Sichuan 641000,China;Department of Respiratory and Critical Medicine,the First People’s Hospital of Neijiang,Neijiang,Sichuan 641000,China)

机构地区：[1]西南医科大学附属医院呼吸与危重症医学科,四川泸州646000 [2]内江市第一人民医院重症医学科,四川内江641000 [3]内江市第一人民医院呼吸与危重症医学科,四川内江641000

出　　处：《临床肺科杂志》2022年第6期828-832,共5页Journal of Clinical Pulmonary Medicine

基　　金：内江市科技计划项目(No.Z201961)。

摘　　要：目的探究超声心排血量监测联合被动抬腿试验在老年机械通气患者中预测撤机结局的价值。方法采用前瞻性自身对照研究,选取准备撤机的老年患者共45例。撤机前行被动抬腿试验(PLR),试验前后使用超声心排血量监测(USCOM)测量其血流动力学指标,根据撤机结果分为两组。比较两组患者一般临床资料、PLR前后血流动力学指标变化及每搏量(SV)、心输出量(CO)、心指数(CI)的变化率、预后转归。用受试者工作特征(ROC)曲线评价ΔSV、ΔCI、ΔCO对撤机成功的预测效能。结果45例患者中撤机成功30例,失败15例。撤机失败组ΔCO、ΔCI均小于撤机成功组,差异有统计学意义(P<0.001),两组ΔSV无统计学差异(P=0.087);ROC曲线评价ΔSV、ΔCI、ΔCO对撤机成功结局的预测效能显示AUCSV=0.658,AUCCI=0.821,AUCCO=0.822。ΔCO以6.93%为截断值,诊断敏感度为0.833,特异性为0.8;ΔCI以8.9%为截断值,诊断敏感度为0.767,特异为0.867。结论超声心排血量监测联合被动抬腿试验测得ΔCI、ΔCO对老年机械通气患者撤机成功结局的预测有较高价值。Objective To explore the predictive value of ultrasonic cardiac output monitoring with passive-leg-raising test for the extubation outcome of elderly ventilated patients.Methods A prospective self-control study was conducted in 45 elderly patients who were about to weaning.Before the extubation,passive leg raising test(PLR)was performed.Ultrasound cardiac output monitoring(USCOM)was used to measure the hemodynamic parameters before and after the test.The patients were divided into two groups according to the outcome of extubation.The clinical data,changes of hemodynamic parameters,rate of change stroke volume(SV),cardiac output(CO),cardiac index(CI)and prognosis were compared between the two groups.The receiver operating characteristic(ROC)curve was used to evaluate the predictive efficiency of ΔSV,ΔCI andΔCO on the success of extubation.Results Among the 45 patients,30 cases were successfully weaning and 15 cases were not.The ΔCO and ΔCI of the failure group were lower than those of the successful group,and the difference was statistically significant(P<0.001).There was no statistical difference inΔSV between the two groups(P=0.087).The predictive efficacy of ΔSV,ΔCI and ΔCO on the successful extubation showed that AUCSV=0.658,AUCCI=0.821,and AUCCO=0.822.The cut-off value of ΔCO was 6.93%.The diagnostic sensitivity and specificity were 0.833 and 0.8 respectively.The cut-off value of ΔCI was 8.9%,and the diagnostic sensitivity and specificity were 0.767 and 0.867 respectively.Conclusion ΔCI and ΔCO measured by passive leg raising test with ultrasound cardiac output monitoring have high value in predicting the success of extubation in elderly ventilated patients.

关 键 词：超声心排血量监测 机械通气 老年 撤机 

分 类 号：R563.8[医药卫生—呼吸系统]