浅快呼吸指数对COPD机械通气病人撤机的意义

Clinical study of rapid-shallow-breathing index as a weaning predictor in mechanical ventilation patients with chronic obstructive pulmonary disease

目的 研究浅快呼吸指数 (RSBI,f/Vt)对慢性阻塞性肺病 (COPD)机械通气病人撤机的指导意义。方法 对符合临床撤机条件的 132例COPD机械通气病人 ,在无任何呼吸支持条件下测定RSBI值 ,然后进行撤机试验 ,并对符合撤机条件者进行撤机 ,观察RSBI值与撤机结果之间的关系。结果 撤机成功组 80例 ,RSBI值为 6 4 .97± 2 6 .84bpm/L ;撤机失败组 5 2例 ,RSBI值为 85 .6 7± 2 8.5 2bpm/L ;撤机失败组的RSBI明显高于成功组 (P <0 .0 5 )。撤机成功组中 ,6 8例RSBI≤ 10 5bpm/L ,12例 >10 5bpm/L ;失败组中 ,34例RSBI≤ 10 5bpm/L ,18例 >10 5bpm/L ;以RSBI≤ 10 5bpm/L为标准 ,其预测撤机成功的灵敏度为 85 .0 % ,特异度为 34.6 %。结论 RSBI对COPD机械通气病人的撤机有一定指导意义。

Objective To evaluate the significance of rapid-shallow-breathing index (RSBI) as a weaning predictor in mechanical ventilation patients with chronic obstructive pulmonary disease (COPD). Methods In 132 COPD patients who met the clinical weaning criteria, their RSBIs were measured under no pressure support at the beginning of a spontaneous breathing trial. The RSBIs in different outcomes of weaning were compared. Results In successful weaning group of 80 patients, RSBI was 64.97±26.84 bpm/L; in 52 patients with weaning failure, RSBI was 85.67±28.52 bpm/L, which was significantly higher than that in successful weaning patients(P<0.05). In successful weaning group, 68 patients' RSBI≤105 bpm/L and 12 patients' RSBI>105 bpm/L;34 and 18 respectively in failed weaning group. Using a RSBI≤105 bpm/L as the threshold value for prospectively predicting successful weaning, the sensitivity, specificity were 85 0%, 34 6% respectively. Conclusion Rapid-shallow-breathing index was a valuable predictor for the patients with COPD to wean from mechanical ventilation.