气囊压力变化值在AECOPD机械通气患者拔管结局中的预测价值  

The predictive value of endotracheal tube cuff pressure change in the outcome of extubation in mechanically ventilated patients with AECOPD

作　　者：陈敏 冷婷 黄霞红 刘晓丽[1] 贾平 杜国雪 张娟 CHEN Min;LENG Ting;HUANG Xiahong;LIU Xiaoli;JIA Ping;DU Guoxue;ZHANG Juan(Department of Critical Care Medicine,Deyang People’s Hospital,Deyang 618000,Sichuan,China;Neurosurgical ICU,Sichuan Academy of Medical Sciences&Sichuan Provincial People’s Hospital,Chengdu 610072,Sichuan,China)

机构地区：[1]德阳市人民医院重症医学科,四川德阳618000 [2]四川省医学科学院/四川省人民医院神外监护室,四川成都610072

出　　处：《中国现代医生》2025年第4期11-15,共5页China Modern Doctor

基　　金：四川省科技计划重点研发项目(2023YFS0070);2023年四川护理职业学院自然科学课题资助(2023ZRY21)。

摘　　要：目的探讨气囊压力变化值(endotracheal tube cuff pressure change,ΔPcuff)在慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary diseas,AECOPD)机械通气患者拔管结局中的预测价值。方法选取2023年3月至2024年8月德阳市人民医院重症医学科收治的行机械通气至少48h且通过自主呼吸试验(spontaneous breathing trial,SBT)需要拔管的93例AECOPD患者为研究对象,根据拔管结局将其分为拔管成功组和拔管失败组。比较两组患者的一般临床资料、实验室检查结果、SBT开始时和30min时的ΔPcuff,采用二元Logistic回归分析影响AECOPD患者拔管结局的风险因素,通过受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价ΔPcuff对拔管结局的预测价值。结果93例患者中拔管成功81例,拔管失败12例。单因素分析显示ΔPcuff(SBT开始时)、ΔPcuff(SBT 30min)、收缩压、pH、动脉血氧分压、动脉血二氧化碳分压、氧合指数均是拔管结局的影响因素(P<0.05);二元Logistic回归分析显示ΔPcuff(SBT开始时)是拔管结局的独立危险因素(P<0.05)。ROC曲线显示ΔPcuff(SBT开始时)预测拔管结局的曲线下面积为0.913,敏感度为84.0%,特异性为83.3%,约登指数为0.673,最佳临界值为34.5cmH_(2)O(1cmH_(2)O=0.098kPa)。结论SBT开始时的ΔPcuff对AECOPD机械通气患者的拔管结局具有较好的预测价值,当ΔPcuff≥34.5cmH_(2)O时,患者拔管成功的概率更高。Objective To investigate the predictive value of endotracheal tube cuff pressure change(ΔPcuff)on extubation outcome in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary diseas(AECOPD).Methods A total of 93 AECOPD patients who underwent mechanical ventilation for at least 48 hours and required extubation through spontaneous breathing trial(SBT)from March 2023 to August 2024 in the Department of Critical Care Medicine of Deyang People’s Hospital were selected as study subjects.According to the outcome of extubation,they were divided into successful extubation group and failed extubation group.General clinical data,laboratory results,ΔPcuff at the start and at 30min of SBT were compared between two groups.Binary Logistic regression was used to analyze the risk factors affecting the outcome of extubation in AECOPD patients.The predictive value ofΔPcuff for extubation outcome was evaluated by receiver operating characteristic(ROC)curve.Results Of the 93 patients,81 were successfully extubed and 12 were failed.Univariate analysis showed thatΔPcuff(at the beginning of SBT),ΔPcuff(SBT 30min),systolic blood pressure,pH,arterial partial pressure of oxygen,arterial partial pressure of carbon dioxide,and oxygenation index were all factors influencing the outcome of extubation(P<0.05).Binary Logistic regression analysis showed thatΔPcuff(at the beginning of SBT)was an independent risk factor for extubation outcome(P<0.05).The ROC curve showed thatΔPcuff(at the beginning of SBT)predicted extubation outcome with an area under the curve of 0.913,sensitivity of 84.0%,specificity of 83.3%,and Yoden index of 0.673,with an optimal cutoff of 34.5cmH_(2)O(1cmH_(2)O=0.098kPa).Conclusion TheΔPcuff(at the beginning of SBT)has a good predictive value for the extubation outcome of mechanically ventilated patients with AECOPD,and the probability of successful extubation of a patient is higher when theΔPcuff is≥34.5 cmH_(2)O.

关 键 词：气囊压力变化值 慢性阻塞性肺疾病急性加重期 机械通气 拔管 预测价值 

分 类 号：R454.4[医药卫生—治疗学]