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浅快呼吸指数在两种自主呼吸实验方法中的临床研究

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【中文摘要】:

【中文摘要】目的观察应用压力支持通气(PSV)方法和T-管(T-piece)方法进行自主呼吸实验(SBT)时,浅快呼吸指数(RSBI)和浅快呼吸指数变化水平(△RSBI)在两种方法中有无差异及其对于脱机成功的猜测作用。方法根据患者脱机时自主呼吸实验的方法(PSV或T-piece),将2007年1月-12月我科经口气管插管呼吸机辅助呼吸经筛查需要脱机的208例患者随机分为PSV组和T-piece组,分别进行30min的SBT,记录两组患者在SBT3min和30min时的气道闭合压(P0.1),呼吸频率(f),潮气量(Vt),根据RSBI计算公式:RSBI=f/Vt,分别算出PSV组和T-piece组SBT3min和30min时RSBI的均值,计算SBT30min时RSBI较SBT3min时的增加幅度即RSBI变化水平(△RSBI=[RSBI(30min)-RSBI(3min)]/RSBI(3min)×100%),比较两组SBT30min时RSBI和△RSBI及每组中脱机成功和失败患者RSBI和△RSBI有无差异,并分别描绘PSV组和T-piece组RSBI和△RSBI与脱机成功的ROC曲线,寻找猜测脱机成功较好的阈值。结果208例患者中男性117例,女性91例,年龄为20-94岁,均匀71.28 /-11.47岁,内科患者145例,外科术后转ICU脱机患者63例,机械通气时间为1-28天,均匀4.68 /-3.73天,脱机成功168例,失败40例,脱机成功率80.77%。PSV组患者93例,T-piece组患者115例,PSV组和T-piece组在患者年龄,性别,机械通气时间上均无明显差异。PSV和T-piece两组的脱机成功率分别为83.87%和78.26%,(P=0.307),无明显差异,PSV组SBT30min时的RSBI均值为67.18 /-11.55(次/min·L),T-piece组SBT30min时的RSBI均值为99.11 /-15.53(次/min·L),(P=0.000);PSV组△RSBI均值为69 /-33%,T-piece组△RSBI均值为119 /-35%,(P=0.000);PSV组RSBI的ROC曲线下面积=0.747 /-0.045,95%可信区间=0.658-0.835,(P=0.000),当RSBI=75次/(min×L),敏感性=0.919,特异性=0.571,阳性猜测值=0.923,阴性猜测值=0.600,诊断正确率=87%,在PSV方法进行SBT时猜测脱机成功较好;△RSBI的ROC曲线下面积=0.709 /-0.065,95%可信区间=0.582-0.835,(P=0.001),当△RSBI=90%,敏感性=0.865,特异性=0.536,阳性猜测值=0.905,阴性猜测值=0.421,诊断正确率=82%,在PSV方法进行SBT结束时RSBI增加水平≤90%猜测脱机成功较好;T-piece组RSBI的ROC曲线下面积=0.821 /-0.049,95%可信区间为0.725-0.916,(P=0.000),当RSBI=100次/(min×L),敏感性=0.833,特异性=0.781,阳性猜测值=0.924,阴性猜测值=0.558,诊断正确率=82%,在T-piece方法进行SBT时猜测脱机成功较好;△RSBI的ROC曲线下面积=0.738 /-0.046,95%可信区间=0.648-0.829,P=0.000;△RSBI=130%时,敏感性=0.833,特异性0.560,阳性猜测值=0.872,阴性猜测值=0.483,诊断正确率=77%,在T-piece方法进行SBT结束时RSBI的增加水平≤130%猜测脱机成功较好。结论使用PSV方法进行SBT时,SBT30min时的RSBI明显小于T-piece方法,PSV组SBT30min时,RSBI=75次/(min×L),猜测脱机成功较好,T-piece组SBT30min时,RSBI=100次/(min×L),猜测脱机成功较好。脱机失败患者△RSBI较成功患者有明显升高,PSV组SBT结束时△RSBI≤90%,猜测脱机成功较好,T-piece组SBT结束时△RSBI≤130%,猜测脱机成功较好,可见,动态观察RSBI的变化对猜测脱性能否成功也是很有价值的。');
【Abstract】 Objective To determine the significance and threshold value of rapid-shallow-breathing index(RSBI)and its increased percent(ΔRSBI)as predictors for successfully weaning in spontaneous breathing trial(SBT)with pressure support ventilation(PSV)and T-piece.Methods In 2007,There were 208 patients on ventilators in 1-28 days with oral intubation.Based on SBT with PSV or T-piece,208 patients were divided into two groups:the PSV group and the T-piece group.The duration of SBT was 30min.Record weaning indexes[mouth occlusion pressure 0.1(P0.1),tidal volume(Vt),breathing rate(f)]of SBT3min and 30min in each group. Calculated and compared the average of RSBI(SBT3min and 30min,RSBI=f/Vt)andΔRSBI(ΔRSBI=[RSBI(30min)-RSBI(3min)]/RSBI(3min)×100%)in each group.Use the receiver operating characteristic(ROC)curve to analyze and determine the sensitivity,specificity and the threshold value of RSBI andΔRSBI as predictors for successfully weaning.Results 208 patients included 117 male and 91 female patients.The age was 20-94 years old and average was 71.28 /-11.47 years old.63 patients were after surgery operations and 145 patients were not.The duration of ventilation was 1-28 days,the average was 4.68 /-3.73 days.168 patients were successfully weaning from ventilator and 40 patients were failed.The achievement ratio of ventilator weaning is 80.77%.The PSV group had 93 patients and the T-piece group had 115 patients.The average of age,ratio of male and female,duration of ventilation were not significant different between the two groups.The achievement ratio of PSV group and T-piece group were 83.87%and 78.26%,(P=0.307),the different between the two groups was not significant.In PSV group,the average of RSBI(SBT30min)was 67.18 /-11.55(breaths/min·L);In T-piece group,the average of RSBI(SBT30min)was 99.11 /-15.53(breaths/min·L),(P=0.000).The different was significant between the two groups.In PSV group,the average ofΔRSBI was 69 /-33%;In T-piece group,the average ofΔRSBI was 119 /-35%,(P=0.000).The different was significant between the two groups.In PSV group,the area of ROC curve of RSBI was 0.747 /-0.045,the 95%confidence interval was 0.658-0.835, (P=0.000);using RSBI=75(breaths/min·L)as the threshold value for predicting successful weaning,the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy were 0.919,0.571,0.923,0.600 and 87% respectively;the area of ROC curve of ARSBI was 0.709 /-0.065,the 95% confidence interval was 0.582-0.835,(P=0.001),using ARSBI=90%as the threshold value for predicting successful weaning,the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy were 0.865,0.536,0.905,0.421 and 82%respectively.In T-piece group,the area of ROC curve of RSBI was 0.821 /-0.049,the 95%confidence interval was 0.725-0.916, (P=0.000);using RSBI=100(breaths/min·L)as the threshold value for predicting successful weaning,the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy were 0.833,0.781,0.924,0.558 and 82% respectively;the area of ROC curve of ARSBI was 0.738 /-0.046,the 95% confidence interval was 0.648-0.829,(P=0.000),usingΔRSBI=130%as the threshold value for predicting successful weaning,the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy were 0.833,0.560,0.872,0.483 and 77%.Conclusions The average of RSBI(SBT30min) of T-piece Group was significant higher than PSV group.In PSV group,using RSBI=75(breaths/min·L)as the threshold value for predicting successful weaning was better than other values.In T-piece Group,the threshold value was RSBI=100(breaths/min·L).In the duration of SBT,to continual observe the increased percent of RSBI(ΔRSBI)was important in predicting successful weaning,too.In PSV group,at the end of SBT,when theΔRSBI≤90%the prognosis of weaning was better. In T-piece group,at the end of SBT,when theΔRSBI≤130%the prognosis of weaning was better.

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本文TAGS: 呼吸 临床 研究 方法 实验 指数 自主 RSBI the

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