肺部超声评分与累积液体平衡相关性及二者对腹腔感染患者拔管结局的预测价值  

Correlation analysis between lung ultrasound score and cumulative fluid balance and their predictive value of extubation outcome in patients with intro-abdominal infection

作　　者：顾彩虹 任华建 管增淦 李小民 Gu Caihong;Ren Huajian;Guan Zenggan;Li Xiaomin(Intensive Care Unit,Affiliated Lianyungang Hospital of Xuzhou Medical University,Xuzhou 222000,China;Institute of General Surgery,Eastern Theater Command General Hospital,Nanjing 210008,China;Intensive Care Unit,Xuzhou City Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州医科大学附属连云港医院重症医学科,连云港222000 [2]东部战区总医院普外科研究所,南京210008 [3]徐州市中心医院重症医学科,徐州221009

出　　处：《中华急诊医学杂志》2023年第2期247-252,共6页Chinese Journal of Emergency Medicine

基　　金：连云港市科技计划项目(SH1601)。

摘　　要：目的探讨自主呼吸试验(spontaneous breathing trial,SBT)末即拔管前肺部超声评分(lung ultrasound score,LUS)与拔管前48 h累积液体平衡相关性及二者对腹腔感染(intro-abdominal infection,IAI)机械通气患者拔管结局的预测价值。方法采用回顾性研究,通过收集三家医院2017年10月1日至2018年9月30日IAI机械通气大于48 h的患者。收集记录常规人口统计学变量及临床特征。根据拔管后能否维持自主呼吸48 h分为拔管成功组和拔管失败组。比较两组患者SBT末(拔管前)LUS及48 h累积液体平衡不同,采用双变量相关分析LUS与48 h累积液体平衡以及二者与浅快呼吸指数(shallow fast breathing index,RSBI)及氨基末端B型利尿肽前体(precursor protein of BNP,pro-BNP)的相关性。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析两者对拔管失败的预测价值。结果共有207例患者进入研究。两组患者拔管前LUS[12(10,14)分vs.16(14,17)分]、累积液体平衡[-318(-1116,200)mL vs.1140(685,1614)mL]、RSBI[60(55,66)(次/min)/L vs.70(65,78)(次/min)/L]、pro-BNP[250(122,1292)pg/mL vs.1156(285,4346)pg/mL]、腹内压(intro-abdominal pressure,IAP)>15 mmHg[32.8%vs.46.6%],ICU住院时间[8(6,12)d vs.11(8,14)d]差异有统计学意义(P<0.05)。Logistic回归显示COPD病史、RSBI、SBT末LUS及拔管前48 h累积液体平衡是拔管失败独立危险因素。相关分析显示LUS与48 h累积液体平衡中度相关(r=0.41,P<0.001),与RSBI弱相关(r=0.381,P<0.001),与pro-BNP呈弱相关(r=0.220,P<0.001),48 h累积液体平衡与RSBI呈弱相关(r=0.31,P<0.001),与pro-BNP无明显相关性。SBT末LUS及拔管前48 h累积液体平衡对拔管失败有预测价值[AUC分别为0.87(95%CI:0.82~0.91),0.89(95%CI:0.85~0.94),P均<0.001]。结论腹腔感染机械通气患者SBT末(拔管前)LUS与48 h累计液体平衡呈中度相关,SBT末(拔管前)LUS及累积48 h液体平衡对拔管失败有一定的预测价值。Objective To investigate the correlation between lung ultrasound score at the end of spontaneous breathing trial(SBT)and cumulative fluid balance at 48 h and their predictive value of extubation outcome in patients with intro-abdominal infection(IAI)under mechanical ventilation.Methods A retrospective study was conducted.Patients with IAI under mechanical ventilation for more than 48 h were collected from three hospitals from October 1,2017 to September 30,2018.Routine demographic variables and clinical characteristics were recorded.The patients were divided into the successful extubation group and failed extubation group according to whether they could maintain spontaneous breathing for 48 h after extubation.LUS at the end of SBT(before extubation)and cumulative fluid balance at 48 h were compared between the two groups.LUS and cumulative fluid balance at 48 h were analyzed by bivariate correlation analysis,and their correlations with shallow fast breathing index(RSBI)and precursor protein of BNP(Pro-BNP)were analyzed.The predictive value of LUS at the end of SBT(before extubation)and cumulative fluid balance for extubation failure were analyzed by receiver operating characteristic curve(ROC).Results Totally 207 patients were enrolled.There were significant differences in LUS before extubation[12(10,14)vs.16(14,17)points],cumulative fluid balance[-318(-1116,200)mL vs.1140(685,1614)mL],RSBI[60(55,66)(times/min)/L vs.70(65,78)(times/min)/L],pro-BNP[250(122,1292)pg/mL vs.1156(285,4346)pg/mL],IAP>15 mmHg[32.8%vs.46.6%],and ICU stay[8(6,12)days vs.11(8,14)days](P<0.05).Logistic regression analysis showed that the COPD history,RSBI,LUS at the end of SBT,and cumulative fluid balance at 48 h before extubation were independent risk factors for extubation failure.Correlation analysis showed that LUS was moderately correlated with cumulative fluid balance at 48 h(r=0.41,P<0.001),weakly correlated with RSBI(r=0.381,P<0.001),and weakly correlated with pro-BNP(r=0.220,P<0.001).Cumulative fluid balance at 48 h was weakly corre

关 键 词：肺部超声评分 累积液体平衡 腹腔感染 拔管 

分 类 号：R459.7[医药卫生—急诊医学]