超声心动图及血气分析在心力衰竭患儿机械通气撤机中的预测价值  

Predictive Value of Echocardiography and Blood Gas Analysis in Mechanical Ventilation Weaning of Children with Heart Failure

作　　者：杨士斌[1] 唐晓娜[2] 张莲 封丽洁 王盼 YANG Shibin;TANG Xiaona;ZHANG Lian;FENG Lijie;WANG Pan(Department of Pediatrics,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China;Neurology Department II,Hebei Children’s Hospital,Shijiazhuang 050000,Hebei,China;Department of Pediatrics,Dingzhou People’s Hospital,Dingzhou 073000,Hebei,China)

机构地区：[1]河北医科大学第二医院儿科,石家庄市050000 [2]河北省儿童医院神经内二科,石家庄市050000 [3]定州市人民医院儿科,定州市073000

出　　处：《中国分子心脏病学杂志》2023年第6期5759-5764,共6页Molecular Cardiology of China

基　　金：河北省卫生健康委员会资助项目(20200911)。

摘　　要：目的 分析超声心动图及血气分析相关指标对心力衰竭患儿机械通气撤机结局的预测价值。方法 选取2018年1月—2020年1月收治的因心力衰竭需行机械通气的83例患儿,根据撤机结局将患儿分为成功组(65例)及失败组(18例),比较两组患儿一般资料,检测所有患儿撤机前24 h及撤机后2 h的左室射血分数(left ventricular ejection fraction,LVEF)、左心房内径(left atrial diameter,LAD)、二尖瓣舒张早期与舒张晚期血流峰值速度比值(E/A)、血氧饱和度(SaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))及酸碱度(pH),采用受试者操作特征(receiver operator characteristic,ROC)曲线分析超声心动图及血气分析相关指标对患儿撤机结局的预测价值。结果 撤机前24 h,成功组与失败组患儿LVEF、LAD、E/A及SaO_(2)、PaCO_(2)、PaO_(2)及pH比较,差异无统计学意义(P> 0.05);成功组拔管后2 h,LVEF、LAD、E/A及SaO_(2)、PaCO_(2)、PaO_(2)及pH与同组撤机前24 h比较,差异无统计学意义(P> 0.05);失败组拔管后2 h LVEF、E/A、SaO_(2)、PaO_(2)及pH低于同组撤机前24 h及成功组拔管后2 h(P <0.05),LAD及PaCO_(2)高于同组撤机前24 h及成功组拔管后2 h(P <0.05)。ROC曲线显示,LVEF、LAD、E/A、SaO_(2)、PaCO_(2)、PaO_(2)及pH预测撤机结局的曲线下面积分别为0.813、0.850、0.823、0.779、0.824、0.759及0.775。结论 撤机后2 h超声心动图及血气分析相关指标能够预测患儿撤机结局,应重点关注撤机失败高风险患儿并尽早干预。Objective To analyze the predictive value of echocardiography and blood gas analysis related indicators on the mechanical ventilation weaning outcome of children with heart failure.Methods From January 2018 to January 2020,83 children who needed mechanical ventilation due to heart failure were selected and divided into successful group(65 cases) and failure group(18 cases) according to the outcome of weaning,the general information of children in the two groups was compared,the left ventricular ejection fraction(LVEF),left atrial diameter(LAD),ratio of mitral valvular early diastolic peak velocity/mitral valvular end diastolic peak velocity(E/A),blood oxygen saturation(SaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),arterial partial pressure of oxygen(PaO_(2)) and pH were detected at 24 h before weaning and 2 h after weaning,receiver operating characteristic(ROC) curve was used to analyze the predictive value of echocardiography and blood gas analysis related indicators for the weaning outcome of children.Results AT 24 h before weaning,there was no significant difference in LVEF,LAD,E/A,SaO_(2),PaCO_(2),PaO_(2) and pH between the successful group and the failure group(P >0.05);there was no significant difference in LVEF,LAD,E/A,SaO_(2),PaCO_(2),PaO_(2),and pH in the successful group between 2 h after extubation with 24 h before weaning(P >0.05);the LVEF,E/A,SaO_(2),PaO_(2) and pH in the failure group at 2 h after extubation were lower than those in the same group at 24 h before weaning and those in the successful group at 2 h after extubation(P <0.05),and LAD and PaCO_(2) were higher than those in the same group at 24 h before weaning and those in the successful group at 2 h after extubation(P <0.05).The ROC curve showed that the areas under the curve for LVEF,LAD,E/A,SaO_(2),PaCO_(2),PaO_(2) and pH to predict weaning outcome were 0.813,0.850,0.823,0.779,0.824,0.759,and 0.775,respectively.Conclusion Echocardiography and blood gas analysis related indicators at 2 h after weaning can predict the wean

关 键 词：超声心动图 血气分析 心力衰竭 机械通气 撤机结局 

分 类 号：R540.45[医药卫生—心血管疾病] R725.4[医药卫生—内科学]