浅快呼吸指数预测COPD患者撤机的价值

Value of Rapid Shallow Breathing Index in Predicting Successful Extubation in Mechanically Ventilated Patients with COPD.

目的研究浅快呼吸指数（RSBI）对慢性阻塞性肺疾病（COPD）患者撤机的临床价值。方法回顾分析2007年1月～2010年1月收治的64例接受有创机械通气的COPD患者的资料。对符合撤机条件的患者在无任何呼吸支持条件下测定浅快呼吸指数（RSBI），然后进行撤机试验，根据结果将患者分为成功组和失败组。结果撤机成功组43例（67．2％），失败21例（32．8％）。多因素Logistic分析提示RSBI和撤机当日APACHEⅡ评分为预测COPD患者撤机成功的独立因素。ROC曲线分析显示RSBI截尾值为93，预测COPD患者撤机成功的敏感性为74．4％，特异性为81．0％。结论RSBI和撤机当日APACHEⅡ评分为预测COPD患者撤机成功的独立因素。本组COPD患者预测撤机的RSBI值为93，此时RSBI预测COPD患者撤机的敏感性和特异性均较好。

Objective To assess the value of rapid shallow breathing index （RSBI） in predicting successful extubation in mechanically ventilated patients with chronic obstructive pulmonary disease （COPD）. Methods A retrospective review of 64 mechanically ventilated patients with chronic obstructive pulmonary disease from January 2007 to January 2010 was performed. RSBI was measured under no pressure support of all patients who met the clinical weaning criteria followed by a spontaneous breathing trial. Patients were divided into extubation success group and extubation failure group. Results 43 patients（67.2% ） were extubated successfully and 21 patients （32. 8% ）failured. Multivariate Logistic regression analysis indicated that RSBI and acute physiology and chronic health evaluation Ⅱ （A- PACHE Ⅱ ） score were independent predictors of extubation success. Cutoff value was 93 for RSBI determined by receiver operator characteristics curve （ROC） with a sensitivity of 74.4% and specificity of 81.0%. Conclusion RSBI and APACHE II score were independent predictors of extubation success. Cutoff value was 93 for RSBI in our cohort.