护士主导基于肺部超声评估的机械通气患儿脱机困难预测分析研究  

Nurse-led analysis and predicting the risk of difficult weaning in mechanical ventilation for pediatric patients based on lung ultrasound

作　　者：张雯澜 陆华[2] 任宏[2] 夏素琴 罗雯懿[3] Zhang Wenlan;Lu Hua;Ren Hong;Xia Suqin;Luo Wenyi(Department of Intensive Care Medicine,College of Clinical Medicine for Obstetrics&Gynecology and Pediatrics,Fujian Medical University,Fujian Children′s Hospital(Fujian Branch of Shanghai Children′s Medical Center),Fuzhou 350014,China;Department of Intensive Care Medicine,Shanghai Children′s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Nursing,Shanghai Children′s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]福建医科大学妇儿临床医学院、福建省儿童医院(上海儿童医学中心福建医院)重症医学科,福州350014 [2]上海交通大学医学院附属上海儿童医学中心重症医学科,上海200127 [3]上海交通大学医学院附属上海儿童医学中心护理部,上海200127

出　　处：《中国实用护理杂志》2024年第34期2649-2657,共9页Chinese Journal of Practical Nursing

基　　金：福建省自然科学基金项目(2022J011070);中华护理学会科研课题(ZHKYQ202212);上海交通大学医学院护理学科人才队伍建设项目(SJTUHLXK2024)。

摘　　要：目的分析机械通气患儿脱机困难的危险因素,并探讨应用基于肺部超声评估对脱机困难的预测价值,为优化患儿脱机准备、提高成功率提供科学依据。方法采用多中心、前瞻性观察性研究方法,便利抽样法选取2022年9月至2023年5月上海交通大学医学院附属上海儿童医学中心和福建省儿童医院收治的气管插管患儿97例为研究对象,于机械通气48~72 h及首次尝试自主呼吸试验前分别采集肺部超声评分(LUS)、小儿危重病例评分(PCIS)、呼吸氧合功能相关指标及随访脱机结局,分析基于肺部超声评分联合脱机困难相关危险因素对儿童脱机结局的预测效能。结果纳入的97例患儿中男57例,女40例,年龄1个月至14岁;通过随访脱机结局将患儿分为成功脱机组55例,困难脱机组42例。在机械通气治疗的48~72 h时,LUS(OR=2.05,95%CI 1.43~2.94,P<0.01)、PCIS(OR=0.68,95%CI 0.50~0.92,P<0.05)是发生脱机困难的早期危险因素,LUS(≥20分)与PCIS(≤72分)联合应用预测脱机困难风险效能最高,敏感度为61.90%、特异度为96.36%,曲线下面积为0.84。在患儿首次行自主呼吸试验前,LUS(OR=4.29,95%CI 2.36~7.81,P<0.01)、呼吸浅快指数(RSBI)(OR=1.84,95%CI 1.01~3.36,P<0.05)是患儿发生脱机困难的危险因素,LUS(≥16分)与RSBI(>6.4)联合应用预测发生脱机困难风险效能最高,敏感度为76.19%、特异度为90.91%,曲线下面积为0.92。结论儿科ICU专科护士应用基于床旁LUS联合PCIS及RSBI,能够早期有效评估识别患儿脱机困难的风险,并明确危险因素,为实施个体化肺康复护理、帮助患儿顺利脱机提供科学依据。ObjectiveTo analyze the risk factors associated with difficult weaning in mechanical ventilation for pediatric patients and investigate the predictive value of utilizing lung ultrasound assessment to optimize preparation for weaning and enhance success rates,thereby establishing a scientific foundation.MethodsA multi-center,prospective observational study,convenience sampling was utilized to select 97 pediatric patients who underwent endotracheal intubation at the Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine and Fujian Provincial Children's Hospital between September 2022 and May 2023.Lung ultrasound scores(LUS),Pediatric Critical Illness Score(PCIS),indicators related to respiratory oxygenation function and follow-up weaning outcomes were collected within 48-72 hours post-mechanical ventilation and prior to the first spontaneous breathing trial.The predictive efficacy of LUS in conjunction with risk factors associated with weaning difficulty on pediatric weaning outcomes was evaluated independently.ResultsAmong the 97 children studied,there were 57 boys and 40 girls,with ages ranging from 1 month to 14 years.By following up with weaning outcomes,the pediatric patients were divided into 55 cases of successful weaning group and 42 cases of difficult weaning group.During 48-72 hours of mechanical ventilation,LUS(OR=2.05,95%CI 1.43-2.94,P<0.05)and PCIS(OR=0.68,95%CI 0.50-0.92,P<0.05)were early risk factors for subsequent difficulties in weaning.And meantime,the combination of LUS(≥20 points)and PCIS(≤72 points)could effectively predict the risk of difficult weaning with a sensitivity of 61.90%,specificity of 96.36%,and an area under curve value of 0.84.Furthermore,before the first spontaneous breathing test,LUS(OR=4.29,95%CI 2.36-7.81,P<0.05)and rapid shallow breathing index(RSBI)(OR=1.84,95%CI 1.01-3.36,P<0.05)were identified as risk factors for pediatric difficult weaning,and their combination LUS(≥16 points)and RSBI(>6.4)could predict the risk of diffic

关 键 词：超声检查 儿童 预测 机械通气 脱机 

分 类 号：R473.72[医药卫生—护理学]