肺部及膈肌超声联合NT-proBNP预测机械通气撤机失败的价值  

The Value of Lung and Diaphragm Ultrasound Combined with NT-proBNP in Predicting Mechanical Ventilation Failure

作　　者：周俊[1] 李浩[1] 陶珍 ZHOU Jun;LI Hao;TAO Zhen(The Eighth Affiliated Hospital of Sun Yat-sen University,Guangdong Shenzhen 518000)

机构地区：[1]中山大学附属第八医院,广东深圳518000

出　　处：《深圳中西医结合杂志》2022年第4期13-16,共4页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

基　　金：深圳市福田区卫生公益性科研项目(FTWS2019101)。

摘　　要：目的:评估肺部超声、膈肌超声联合氨基末端脑钠肽前体(NT-proBNP)预测机械通气撤机失败的价值。方法:纳入2019年10月至2021年10月中山大学附属第八医院收治的90名经气管插管机械通气>48 h的患者,自主呼吸试验(SBT)开始后分别用床旁超声测量肺部超声评分(LUS)、膈肌增厚分数(DTF)并送检血清NT-proBNP,成功通过SBT 1 h的患者拔除气管插管,观察患者撤机结局及LUS、DTF、NT-proBNP的预测价值。结果:90名患者中,68名(75.6%)撤机成功,22名(24.4%)撤机失败。二元logistic回归分析提示LUS、DTF、NT-proBNP均与有创通气患者撤机失败有关(P<0.05)。受试者工作特征(ROC)曲线显示LUS、DTF、NT-proBNP预测撤机失败的曲线下面积(AUC)分别为0.73、0.87、0.82,预测撤机失败的阈值分别为LUS≥18分、DTF≤32%、NT-proBNP≥1374 pg·mL^(-1),三者联合预测撤机失败的AUC为0.90,较单项指标更高,其灵敏度为91%,特异度为78%。结论:肺部超声、膈肌超声及NT-proBNP能较好的预测撤机失败,三者联合的预测效能比单项更高。Objective To evaluate the value of lung ultrasound and diaphragm ultrasound combined with N terminal pro B type natriuretic peptide(NT-proBNP)in predicting the failure of mechanical ventilation withdrawal.Methods 90 patients with endotracheal intubation mechanical ventilation>48 hours treated in the Eighth Affiliated Hospital of Sun Yat-sen University from October 2019 to October 2021 were included.After the start of spontaneous breathing trial(SBT),the lung ultrasound score(LUS)and diaphragmatic thickening fraction(DTF)were measured with bedside ultrasound,and the NT-proBNP was detected at the same time.Patients who successfully passed the SBT for 1 hour were removed the endotracheal intubation and observed,the outcome of weaning and the predicted values of LUS,DTF and NT-proBNP were observed.Results Among the 90 patients,68 cases(75.6%)were successfully deactivated,and 22 cases(24.4%)were failed.Binary logistic regression analysis showed that LUS,DTF and NTprobNP were all related to the withdrawal failure of patients with invasive ventilation(P<0.05).Receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)of LUS,DTF and NT-proBNP for predicting disconnection failure were 0.73,0.87 and 0.82 respectively.The thresholds for predicting disconnection failure were LUS≥18 points,DTF≤32% and NT-proBNP≥1374 pg·mL^(-1),respectively.The AUC of the three indexes was 0.90,which was higher than that of the single index,and its sensitivity and specificity were 91% and 78%respectively.Conclusion Lung ultrasound,diaphragm ultrasound and NT-proBNP can predict the failure of weaning well,and the prediction efficiency of the combination of the three is higher than that of single.

关 键 词：机械通气 膈肌增厚分数 肺部超声 氨基末端脑钠肽前体 

分 类 号：R459.7[医药卫生—急诊医学]