C反应蛋白/白蛋白联合综合脱机指数对AECOPD并发呼吸衰竭有创机械通气患者撤机失败的预测价值  

Predictive value of C-reactive protein/albumin combined with integrated weaning index for withdrawal failure in patients with AECOPD complicated with respiratory failure with invasive mechanical ventilation

作　　者：王新 张占华 马丽 郭子平 WANG Xin;ZHANG Zhanhua;MA Li;GUO Ziping(Department of Emergency Medicine,Honghui Hospital Affiliated to Xi’an Jiaotong University,Shaanxi Province,Xi’an710100,China;Department of Emergency Medicine,Shangluo Central Hospital,Shaanxi Province,Shangluo726000,China;Department of Emergency Medicine,Affiliated Baoji Hospital of Xi’an Medical University,Shaanxi Province,Xi’an710061,China)

机构地区：[1]西安交通大学附属红会医院急诊医学科,陕西西安710100 [2]陕西省商洛市中心医院急诊医学科,陕西商洛726000 [3]西安医学院附属宝鸡医院急诊医学科,陕西西安710061

出　　处：《中国医药导报》2024年第29期106-110,共5页China Medical Herald

基　　金：陕西省重点研发计划项目(2023-ERCY-08)。

摘　　要：目的分析C反应蛋白/白蛋白(CRP/Alb)联合综合脱机指数(IWI)对慢性阻塞性肺疾病急性加重期(AECOPD)并发呼吸衰竭有创机械通气患者撤机失败的预测效能。方法选择西安交通大学附属红会医院2022年4月至2024年5月行有创机械通气的AECOPD并发呼吸衰竭患者235例,以撤机结局将患者分成撤机成功组、撤机失败组。对比撤机失败组与撤机成功组临床资料、CRP/Alb及IWI,分析AECOPD并发呼吸衰竭患者撤机失败的影响因素,分析CRP/Alb、IWI及二者联合对AECOPD并发呼吸衰竭患者撤机失败的预测价值。结果235例AECOPD并发呼吸衰竭患者中,撤机失败率为20.85%(49/235)。撤机失败组年龄≥60岁、机械通气时间≥14 d、合并多器官功能障碍综合征(MODS)的例数占比,撤机前急性生理和慢性健康状况Ⅱ评分、CRP/Alb高于撤机成功组(P<0.05),撤机失败组IWI低于撤机成功组(P<0.05)。logistic回归分析结果显示,机械通气时间≥14 d(OR=4.133,95%CI:2.175~7.854)、CRP/Alb(OR=3.747,95%CI:1.972~7.121)、合并MODS(OR=2.757,95%CI:1.451~5.239)为AECOPD并发呼吸衰竭患者撤机失败的独立危险因素(P<0.05),IWI(OR=0.243,95%CI:0.128~0.463)为保护因素(P<0.05)。CRP/Alb、IWI及二者联合预测AECOPD并发呼吸衰竭患者撤机失败的曲线下面积(AUC)分别为0.805、0.799、0.905(P<0.05),且二者联合的AUC值高于CRP/Alb、IWI单独预测的AUC值(P<0.05)。结论撤机前CRP/Alb、IWI在预测AECOPD并发呼吸衰竭患者撤机失败中具有重要价值,且二者联合的预测价值比单独指标的预测价值更高。Objective To analyze the predictive efficacy of C-reactive protein/albumin(CRP/Alb)combined with integrated weaning index(IWI)for withdrawal failure in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure with invasive mechanical ventilation.Methods A total of 235 AECOPD patients with respiratory failure who underwent invasive mechanical ventilation in Honghui Hospital Affiliated to Xi’an Jiaotong University from April 2022 to May 2024 were selected,and the patients were divided into successful withdrawal group and failed withdrawal group according to the outcome of withdrawal.The clinical data,CRP/Alb,and IWI of the failed and successful withdrawal groups were compared,and the influencing factors of withdrawal failure in patients with AECOPD complicated with respiratory failure were analyzed,and the predictive value of CRP/Alb,IWI,and their combination on withdrawal failure in patients with AECOPD complicated with respiratory failure was analyzed.Results Among 235 AECOPD patients with respiratory failure,the withdrawal failure rate was 20.85%(49/235).The proportion of cases with age≥60 years,mechanical ventilation duration≥14 d,and multiple organ dysfunction syndrome(MODS),the acute physiology and chronic health evaluation-Ⅱbefore withdrawal,and CRP/Alb in the failed withdrawal group were higher than those in the successful withdrawal group(P<0.05).IWI in the failed withdrawal group was lower than that in the successful withdrawal group(P<0.05).Logistic regression analysis showed that mechanical ventilation duration≥14 d(OR=4.133,95%CI:2.175-7.854),CRP/Alb(OR=3.747,95%CI:1.972-7.121),combined MODS(OR=2.757,95%CI:1.451-5.239)were independent risk factors for withdrawal failure in patients with AECOPD with respiratory failure(P<0.05),and IWI(OR=0.243,95%CI:0.128-0.463)was a protective factor(P<0.05).The area under the curve(AUC)of CRP/Alb,IWI,and their combination in predicting AECOPD patients with respiratory failure were 0.805,0.799,and 0

关 键 词：C反应蛋白/白蛋白 综合脱机指数 慢性阻塞性肺疾病急性加重期 呼吸衰竭 有创机械通气 撤机失败 预测价值 

分 类 号：R563.8[医药卫生—呼吸系统]