咳嗽峰流速对急性呼吸衰竭患儿撤机结果的预测价值

Cough peak expiratory flow in prediction of successful extubation for mechanically ventilated children with acute respiratory failure

目的探讨咳嗽峰流速(CPEF)测定对急性呼吸衰竭患儿拔管脱机结果的预测价值。方法选择62例急性呼吸衰竭患儿,所有患儿均机械通气超过72 h,意识清楚,且已顺利通过自主呼吸试验30 min。根据拔管结果将患儿分为拔管成功组与失败组,比较两组患儿拨管前CPEF、肺功能指标、血气分析结果、小儿危重病例评分(PCIS)。结果 52例患儿拔管成功,10例患儿拔管失败。拔管成功组患儿的CPEF值明显高于失败组,差异有统计学意义(P<0.01)。根据CPEF预测撤机成功所作ROC曲线下面积为0.873(P<0.01),其最佳临界值为40.5 L/min,以CPEF≥40.5 L/min预测撤机成功的灵敏度为76.9%,特异度为90%。结论测定CPEF可预测机械通气患儿的撤机结果。

Objectives To study the value of cough peak expiratory flow（CPEF） in predicting extubation outcome of children with acute respiratory failure.Methods A total of 62 children with acute respiratory failure were selected and received mechanical ventilation longer than 72 hours.They were conscious at the time of extubation and successfully got through 30 minutes of spontaneous breathing trial.Children were divided into success group and failure group according to the outcome of extubation.CPEF,pulmonary function parameters,blood gas analysis and pediatric critical illness scores were compared before extubation between two groups.Results Fifty-two cases were successfully extubated but 10 cases failed.CPEF of the success group was significantly higher than that of the failure group（P＆lt;0.01）.Based on the results of receiver operating characteristic curves,the area under the curve was 0.873.The optimal operating point of CPEF was 40.5L/min,and the sensitivity and specificity were 76.9% and 90.0%,respectively（P＆lt;0.01）.Conclusions It is suggested that CPEF can be used as a predictor of extubation outcome.