COPD机械通气病人撤参数分析

目的研究闭合气道压（P0．1）、急性生理与慢性健康状况（APACHE）Ⅱ评分、血浆白蛋白（AIb）水平、浅快呼吸指数（RSBI）在慢性阻塞性肺病（COP13）机械通气病人撤机时的指导意义。方法对126例符合临床撤机条件的COPD机械通气病人测定P0．1、APAGHEⅡ评分、AIb水平、RSBI值、然后进行撤机试验、并观察上述指标与撤机结果之间的关系。结果撤机成功组76例、P0．1值为（220±0．56）cmH2O、APACHEⅡ评分为225±2．7、AIb值为（554±4．9）g／L、RSBI值为（64．17±25．64）bpm／L；撤机失败组50例，P0．1值为（4．25±0．71）cmH2O、APACHEⅡ评分为298±52、AIb值为（26．5±8．4）g／L、RSBI值为（87．62±26．52）bpm／L。撤机失败组的P0.1值、APACHEⅡ评分、R8BI明显高于成功组（“P〈0．05”）。撤机成功组的AIb值明显高于撤机失败组（“P〈0．05”）。撤机成功组中、70例P0.1≤6cmH2O，67例RSBI≤105bpm／L，6例P0.1〉6cmH2O，9例RSBI〉105bpm／L；失败组中，17例P0．1≤cmH2O、31例PSBI≤105bpm／L，33例P0．1〉6cmH2O，19例PSBI〉105bpm／L。以P0．1≤cmH2O、RSBI≤105bpm／L为标准、其预测撤机成功的灵敏度分别为92．11％、88．16％、特异度分别为66.0％、58．0％。结论P0．1、APACHEⅡ评分、AIb、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 airway occlusion pressure （P0.1）, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ）, albumin（Alb）, rapid - shallow - breathing index （RSBI） as a weaning predictor in mechanical ventilation patients with chronic obstructive pulmonary disease （COPD）. Methods In 126 COPD patients who met the clinical weaning criteria, their P0.1, APACHE Ⅱ, Alb and RSBIs were measured. The P0.1, APACHE Ⅱ, Alb and RSBIs in different outcomes of weaning were compared. Results In successful weaning group of 76 patients, P0.1 was （2.20±0.56）cmH2O, APACHE Ⅱ was 22.3 ±2.7, Alb was （33.4 ±4. 9） g/L, RSBI was （64. 17 ±25.64） bpm/L ; in 50 patients with weaning failure, P0.1 was （4.25±0.71）crnH2O, APACHE Ⅱ was 29. 8 ±3.2, Alb was （26. 5 ±8.4） g/L, RSBI was （87.62±26. 32） bpm/L, The P0.1, APACHE Ⅱ and RSBI in weaning failure were significantly higher than that in successful weaning patients（＂P 〈 0. 05＂）. The Alb in successful weaning patients were significantly higher than that in weaning failure. In successful weaning group, 70 patients＇P0.1 ≤ 6 cmH2O, 67 patients＇ RSBI ≤ 105 bpm/L, 6 patients＇P0.1〉 6 cmH2O, 9 patients＇RSBI 〉 105 bpm/L ;17,31,33, 19 respectively in failed weaning group. Using a P0.1 ≤ 6 cmH2O, RSBI ≤105 bpm/L as the threshold value for prospectively predicting successful weaning, the sensitivity were 92.11%, 88.16 %, specificity were 66%, 38.0 % respectively. Conclusion P0.1, APACHE Ⅱ, Alb, RSBI was a valuable predictor for the patients with COPD to wean from mechanical ventilation.