膈肌超声联合25(OH)D_(3)和NT-proBNP检测在老年COPD机械通气撤机结局中的预测价值  

Value of diaphragm ultrasound combined with 25(OH)D_(3) and NT-proBNP in predicting the outcome of mechanical ventilation weaning in COPD patients

作　　者：周金红 付左骏 刘丹[1] 王嘉琪 刘庆华[1] ZHOU Jinhong;FU Zuojun;LIU Dan;WANG Jiaqi;LIU Qinghua(Ultrasound Department,Wenzhou Medical University Affiliated Quzhou Hospital(Quzhou People's Hospital),Quzhou,Zhejiang 324000,China)

机构地区：[1]温州医科大学附属衢州医院<衢州市人民医院>超声科,浙江衢州324000

出　　处：《医药前沿》2024年第16期53-57,共5页Journal of Frontiers of Medicine

基　　金：衢州市科技攻关指导性项目(2021030)。

摘　　要：目的:探讨膈肌超声联合25-羟维生素D_(3)[25(OH)D_(3)]、N末端脑钠肽前体(NT-proBNP)检测在老年慢性阻塞性肺疾病(COPD)机械通气撤机结局中的预测价值。方法:选取2022年7月—2023年6月在温州医科大学附属衢州医院ICU行机械通气的128例COPD患者,首次开始自主呼吸测试(SBT)当天进行实验室检查,SBT时通过超声检查测量膈肌位移(De)、呼气末膈肌厚度(DTee)、膈肌增厚率(DTF),根据首次撤机结局分为撤机成功组97例和撤机失败组31例,比较两组临床资料、膈肌超声指标、25(OH)D_(3)、NT-proBNP水平,采用Logistic回归分析撤机结局的影响因素,采用受试者工作特征(ROC)曲线分析膈肌超声指标和实验室指标预测撤机结局的价值。结果:撤机失败组患者机械通气时间、急性生理与慢性健康(APACHeⅡ)评分、浅快呼吸指数(RSBI)、C反应蛋白(CRP)、NT-proBNP水平高于撤机成功组,De、DTee、DTF、25(OH)D_(3)低于撤机成功组,差异有统计学意义(P<0.05);机械通气时间、RSBI、APACHeⅡ评分、De、DTF、25(OH)D_(3)、NT-proBNP是影响机械通气撤机结局的主要因素,差异有统计学意义(P<0.05)。De、DTF、25(OH)D_(3)、NT-proBNP以及联合应用预测机械通气患者撤机结局的AUC为0.737、0.713、0.727、0.661、0.845,联合应用的AUC大于其他单一指标,差异有统计学意义(P<0.05)。结论:De、DTF、25(OH)D_(3)、NT-proBNP对COPD机械通气撤机结局有良好的预测价值,联合应用预测撤机结局更准确,可用于指导临床撤机。Objective To investigate the value of diaphragm ultrasound combined with 25-hydroxyvitamin D_(3)[25(OH)D_(3)]and N-terminal brain natriuretic peptide precursor(NT-proBNP)in predicting the outcome of mechanical ventilation weaning in elderly chronic obstructive pulmonary disease(COPD)patients.Methods A total of 128 COPD patients receiving mechanical ventilation of ICU of Wenzhou Medical University Affiliated Quzhou Hospital from July 2022 to June 2023 were selected for laboratory examination on the first day of spontaneous breathing test(SBT).During SBT,diaphragm excursion(DE),diaphragmatic thickness at the end of expiration(DTee)and diaphragm thickening fraction(DTF)were measured by ultrasound.According to the outcome of the first mechanical ventilation weaning,97 cases were divided into the successful weaning group and 31 cases were failed weaning group.The clinical data,diaphragm ultrasound index,25(OH)D_(3) and NT-proBNP levels of the two groups were compared,and the influencing factors of the outcome were analyzed by Logistic regression.Receiver operating characteristic(ROC)curve was used to analyze the value of diaphragm ultrasound and laboratory indicators in predicting the outcome of mechanical ventilation weaning.Results The mechanical ventilation time,Acute Physiology and Chronic Health Evaluation(APACHEⅡ)scores,rapid shallow breathing index(RSBI),C-reactive protein(CRP)and NT proBNP levels in the failed weaning group were higher than those in the successful weaning group,while DE,DTee,DTF,and 25(OH)D_(3) were lower than those in the successful weaning group,with statistical significance(P<0.05).Mechanical ventilation time,RSBI,APACHE II score,DE,DTF,25(OH)D_(3),NT proBNP were the main factors affecting the outcome of mechanical ventilation weaning,and the difference was statistically significant(P<0.05).The AUC of DE,DTF,25(OH)D_(3),NT proBNP,and their combined use in predicting the withdrawal outcome of mechanical ventilation patients were 0.737,0.713,0.727,0.661,and 0.845,respectively.The AUC of the

关 键 词：慢性阻塞性肺疾病 机械通气 撤机 25-羟维生素D_(3) N末端脑钠肽前体 超声 膈肌 

分 类 号：R565[医药卫生—呼吸系统]