血清胆碱酯酶对ICU机械通气患者脱机失败预测价值的倾向评分匹配分析  

Propensity score matching analysis of serum cholinesterase for predicting offline failure in ICU mechanical ventilation patients

作　　者：陈龙 徐晶晶 施飞 陈志祥 CHEN Long;XU Jingjing;SHI Fei;CHEN Zhixiang(ICU,Wuhu Traditional Chinese Medicine Hospital,Wuhu,Anhui 241002,China)

机构地区：[1]芜湖市中医医院重症医学科,安徽芜湖241002

出　　处：《临床肺科杂志》2024年第8期1135-1139,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的 采用倾向评分匹配分析血清胆碱酯酶(SChE)对ICU有创机械通气(IMV)患者脱机失败预测价值。方法 选取2020年6月至2023年6月的IMV患者,收集临床资料,采用倾向评分(PSM)最临近匹配法以1∶1的比例选取脱机失败和脱机成功患者各65例,分析SChE与营养评分的相关性,脱机失败的影响因素,不同因素与患者脱机难度的关系,以及回归模型对脱机失败的预测能力。结果 PSM后脱机失败组SBP、SChE和PaO_(2)低于脱机成功组,HR高于脱机成功组;SBT前HR高于脱机成功组,SChE和PaO_(2)低于脱机成功组,基线和SBT前SChE均与营养评分呈负相关(rs=-0.323,-0.419,P均<0.001)。SBT前SChE、PaO_(2)和HR是IMV患者脱机失败的独立预测因素,且与患者脱机难度密切相关。预测脱机失败的临界值为SBT前SChE<3228.00U/L,HR>80.52次/min, PaO_(2)<87.70 mmHg,三者联合的AUC为0.714(0.647~0.782),高于SBT前SChE的0.641(0.568~0.715),HR的0.618(0.545~0.690)和PaO_(2)的0.590(0.515~0.664)。结论 SChE水平下降与营养不良有关,可对机械通气脱机产生负面影响。SBT前SChE、PaO_(2)和HR是脱机失败和脱机难度的影响因素,三者联合可有效预测IMV患者脱机失败风险。Objective To predict the value of the method of propensity score matching to analyze serum cholinesterase(SChE)for weaning failure in ICU patients with invasive mechanical ventilation(IMV).Methods IMV patients from June 2020 to June 2023 were selected,and their clinical data were collected.65 patients with failed and successful weaning were selected by propensity score(PSM)nearest neighbor matching method in the ratio of 1∶1.The correlation between SChE and nutritional score,the influencing factors of weaning failure,the relationship between different factors and patients′weaning difficulty,and the predictive ability of regression model for weaning failure were analyzed.Results The systolic blood pressure(SBP),SChE and PaO_(2) in the failed weaning group after PSM were lower than those in the successful weaning group,while HR was higher than that in the successful weaning group.HR before spontaneous breathing test(SBT)was higher than that in the successful weaning group,while SChe and PaO_(2) were lower than those in the successful weaning group.The baseline(r s=-0.323,P<0.001)and pre SBT(sr=-0.419,P<0.001)SChE were negatively correlated with nutritional score.SChE,PaO_(2) and HR before SBT were independent predictors of weaning failure in patients with IMV,and were closely related to the difficulty of weaning.The critical value for predicting offline failure were SChE<3228.00 U/L,HR>80.52 times/min,and PaO_(2)<87.70 mmHg before SBT.The combined AUC of the three was 0.714(0.647~0.782),higher than the pre SBT SChE of 0.641(0.568~0.715),HR of 0.618(0.545~0.690),and PaO_(2) of 0.590(0.515~0.664).Conclusion The decrease of SChE level is related to malnutrition,which can have a negative impact on the weaning of mechanical ventilation.SChE,PaO_(2) and HR before SBT are the influencing factors of weaning failure and weaning difficulty.The combination of the three can effectively predict the risk of weaning failure in patients with IMV.

关 键 词：血清胆碱酯酶 有创机械通气 自主呼吸试验 脱机失败 

分 类 号：R459.7[医药卫生—急诊医学]