慢性阻塞性肺疾病有创机械通气量化脱机参数模型的建立

Establishment of quantified weaning parameter model for invasive mechanical ventilation in chronic obstructive pulmonary disease

目的建立针对慢性阻塞性肺疾病（COPD）患者的有创机械通气量化脱机参数模型。方法对已有的64例患者有创机械通气过程中的各项自主呼吸试验参数及附加参数计算均数，采用非参数估计ROC曲线法界定参数的阈值，两分类Logistic回归法得出优似比（OR值），以OR值作为系数，ROC曲线法界定评分的阈值。结果各参数的阴性阈值范围及OR值分别为MV≥8．5L，8．0；f≥20次／min，8．0；P：F≤220，6．0；HR≥90次／min，6．0；年龄≥65岁，5．0；pH≥7．46，5．0；Fi02≥40％，4．5；PaO2≤70mmHg，4．0；舒张压≤75mmHg，4．0；SaO2≤95％，4．0；Vt≥0．360L，4．0；RSBI≥54次·min-1·L-1，3．0；收缩压≥125mmHg，1．5；PaCO2≤40mmHg，1．0。以45分为评分阈值，诊断COPD患者成功脱机拔管结果的诊断符合率为96．2％。结论COPD患者有创机械通气量化脱机参数模型，可将脱机拔管诊断符合率提高到96．2％。期待进一步临床研究证实。

Objective To establish the quantified weaning parameter model for invasive mechanical ventilation in COPD. Methods Mean of paremeters during number of additional parameters were calculated in 64 patients with invasive mechanical ventilation. Threshold was defined using non-parametric estimation of ROC curve for each parameters respectively. Logistic regression method to get two excellent likelihood ratio （ OR ）, with OR values as a factor, ROC curve defined score threshold. Results The parameters of the negative threshold range and OR are MV≥8.5 L,8.0. f≥20 times/min, 8. 0. P ： F≥ 220,6.0. HR≥90 beats/min, 6.0. Age≥65 years,5.0, pH≥7.46,5.0. FiO2≥40%,4.5. PaO2≥ 70 mm Hg,4.0. Diastolic blood pressure≥75 mm Hg,4.0. SaO2≥95≥ ,4.0. Vt≥0. 360 L,4.0. RSBI≥ 54 times, min-1 · L -1,3.0. Systolic blood pressure≥125 mm Hg,l. 5. PaCO2≥40 mm Hg,l.0. Score of 45 is divided into thresholds, pulling off a successful outcome in patients with COPD the diagnosis rate was 96.2≥. Conclusions A quantified weaning parameter model for COPD patients with invasive mechanical ventilation had been established. It has a diagnostic accordance rate of 96.2%. We look forward for further clinical studies.