动态肺顺应性标化的机械功与机械通气患者撤机结局及预后的相关性分析:一项前瞻性观察性队列研究  

Correlation analysis between mechanical power normalized to dynamic lung compliance and weaning outcomes and prognosis in mechanically ventilated patients:a prospective,observational cohort study

作　　者：颜瑶 谢永鹏 杜志强 王小娟 刘璐 李萌 李小民 Yan Yao;Xie Yongpeng;Du Zhiqiang;Wang Xiaojuan;Liu Lu;Li Meng;Li Xiaomin(Department of Critical Care Medicine,the Second People's Hospital of Lianyungang City,Affiliated to Kangda College of Nanjing Medical University,Lianyungang 222000,Jiangsu,China;Department of Emergency Medicine,Lianyungang Clinical College of Nanjing Medical University,the First People's Hospital of Lianyungang City,Lianyungang 222000,Jiangsu,China)

机构地区：[1]南京医科大学康达学院附属连云港市第二人民医院重症医学科,江苏连云港222000 [2]南京医科大学连云港临床医学院(连云港市第一人民医院)急诊科,江苏连云港222000

出　　处：《中华危重病急救医学》2025年第1期36-42,共7页Chinese Critical Care Medicine

基　　金：江苏省连云港市科技局社会发展项目(SF2306);江苏省连云港市卫生科技项目(202322);南京医科大学康达学院科研发展重点项目(KD2023KYJJ051)。

摘　　要：目的探讨动态肺顺应性标化的机械功(Cdyn-MP)与机械通气患者撤机结局及预后的相关性。方法采用前瞻性观察性队列研究方法,选择2022年1月至2023年12月连云港市第一人民医院和连云港市第二人民医院重症监护病房(ICU)收治的有创机械通气(IMV)时间>24 h且使用T管通气策略进行撤机的患者作为研究对象。记录患者的基线资料、入ICU主要病因、首次自主呼吸试验(SBT)期间生命体征及实验室指标、SBT前4 h呼吸力学参数、撤机结局及预后指标。根据简化机械功(MP)公式计算MP和Cdyn-MP。采用单因素和多因素Logistic回归法分析与机械通气患者撤机失败相关的独立危险因素;采用限制性三次样条(RCS)分析及Spearman秩和检验探讨Cdyn-MP与撤机结局及预后的相关性;绘制受试者工作特征曲线(ROC曲线),通过ROC曲线下面积(AUC)评价Cdyn-MP对机械通气患者撤机结局的预测价值。结果最终共纳入IMV患者366例,其中撤机成功组243例,撤机失败组123例,其中有23例患者在首次SBT成功撤机后48 h内再次插管、无创通气或死亡。与撤机成功组相比,撤机失败组患者序贯器官衰竭评分(SOFA)、SBT期间体温及呼吸频率(RR)、SBT前4 h呼吸力学参数〔通气频率、呼气末正压(PEEP)、平台压(Pplat)、吸气峰压(Ppeak)、动态驱动压(ΔPaw)、吸入氧浓度(FiO_(2))、MP、Cdyn-MP〕水平均显著升高,动态肺顺应性(Cdyn)显著降低,IMV时间、ICU住院时间及总住院时间显著延长;而两组患者年龄、性别、体质量指数(BMI)、吸烟史、入ICU主要病因、SBT期间其他生命体征〔心率(HR)、平均动脉压(MAP)、外周血氧饱和度(SpO_(2))〕及实验室指标〔白细胞计数(WBC)、白蛋白(Alb)、血清肌酐(SCr)〕差异均无统计学意义。将单因素Logistic回归分析中P<0.05且与Cdyn-MP无多重共线性的变量纳入多因素Logistic回归模型分析,结果显示,SOFA评分〔优势比(OR)=1.081,95%可�ObjectiveTo explore the correlation between mechanical power normalized to dynamic lung compliance(Cdyn-MP)and weaning outcomes and prognosis in mechanically ventilated patients.MethodsA prospective,observational cohort study was conducted.Patients who underwent invasive mechanical ventilation(IMV)for more than 24 hours and used a T-tube ventilation strategy for extubation in the intensive care unit(ICU)of Lianyungang First People's Hospital and Lianyungang Second People's Hospital between January 2022 and December 2023 were enrolled.The collected data encompassed patients'baseline characteristics,primary causes of ICU admission,vital signs and laboratory indicators during the initial spontaneous breathing trial(SBT),respiratory mechanics parameters within the 4-hour period prior to the SBT,weaning outcomes and prognostic indicators.Mechanical power(MP)and Cdyn-MP were calculated using a simplified MP equation.Univariate and multivariate Logistic regression analyses were utilized to determine the independent risk factors associated with weaning failure in patients undergoing mechanical ventilation.Restricted cubic spline(RCS)analysis and Spearman rank-sum test were employed to investigate the correlation between Cdyn-MP and weaning outcomes as well as prognosis.Receiver operator characteristic curve(ROC curve)was constructed,and the area under the ROC curve(AUC)was computed to evaluate the predictive accuracy of Cdyn-MP for weaning outcomes in mechanically ventilated patients.ResultsA total of 366 patients undergoing IMV were enrolled in this study,with 243 cases classified as successful weaning and 123 cases classified as failed weaning.Among them,23 patients underwent re-intubation within 48 hours after the successful withdrawal of the first SBT,non-invasive ventilation,or died.Compared with the successful weaning group,the patients in the failed weaning group had significantly increased levels of sequential organ failure assessment(SOFA)score,body temperature and respiratory rate(RR)during SBT,and respiratory

关 键 词：标化的机械功 机械通气 撤机结局 预后 

分 类 号：R47[医药卫生—护理学]