不同指标对机械通气的慢性阻塞性肺疾病患者自主呼吸实验成功的预测意义

The comparison of the value of different predictors for the outcome of spontaneous breathing trial in ventilated chronic obstructive pulmonary disease

目的 比较不同指标对机械通气的COPD患者行自主呼吸实验（SBT）结果的预测意义.方法 采用前瞻性单中心观察性研究,选择2009年6月至2013年11月广州医科大学附属第一医院重症医学科收治的AECOPD需要有创机械通气的患者.所有患者准备接受SBT,根据SBT是否成功,分为SBT成功组和SBT失败组.分别记录两组患者的性别、年龄、急性生理和慢性健康评分Ⅱ（APACHEⅡ）、吸氧浓度（FiO2）、SBT前的动态肺顺应性（Cdyn）、呼吸浅快指数（RSBI）、最大吸气负压（MIP）、口腔闭合压（P0.1）、动脉血气分析结果,并计算出呼吸复合指标（CROP和CORE）.比较RSBI、MIP、P0.1、CROP和CORE在两组间的差异.结果 总共入组SBT次数共83次（来源于43例患者）,分为SBT成功组61例,SBT失败组22例.SBT成功组的RSBI、P01小于失败组,分别为：63.57±14.17、76.36±13.03和3.17±0.58、4.26±0.79.而MIP、CROP、CORE大于失败组,分别为24.69±4.71、18.09±2.96,39.39±14.04、15.45±4.89和12.87±5.29、3.76±1.30.以上指标在两组间比较差异均有统计学意义（P＜0.05）.为以上指标描绘ROC曲线,曲线下面积最大为CORE（0.987）,95％可信区间为0～1.000.当CORE＞6时,预测SBT成功敏感性为92％,特异性为96％.结论 CORE是对机械通气COPD患者SBT结局最有意义的预测指标.当CORE＞6时,预测患者SBT的成功率高.

Objective This study aimed to compare the value of different predictors for the outcome of spontaneous breathing trial （SBT） in ventilated COPD.Methods A prospective study was conducted,ventilated AECOPD patients who were ready for SBT in ICU of the First Affiliated Hospital of Guangzhou Medical University from June 2009 to November 2013 were enrolled.According to the outcome of SBT,they were divided into SBT success group and SBT failure group,before SBT,the following factors were recorded：gender,age,APACHE Ⅱ score,FiO2,Cdyn,RSBI,MIP,P0.1,blood gas analysis.and calculate the CROP index and CORE index.Evaluate the difference of RSBI,MIP,P0.1,CROP index and CORE index in 2 groups.Results Total 83 times of SBT （from 43 patients） were recorded,SBT success group 61 cases,SBT failure group 22 cases.The RSBI,P0.1 in SBT success group is lower than SBT failure group （63.57± 14.17,76.36± 13.03 and 3.17±0.58,4.26±0.79）,the MIP,CROP index and CORE index in SBT success group is higher than SBT failure group （24.69 ± 4.71,18.09 ± 2.96,39.39 ± 14.04,15.45 ± 4.89 and 12.87 ± 5.29,3.76 ± 1.30）,there were significant difference in 2 groups for above factors （P 〈0.05）.We calculated receiver operating characteristic curves （ROC） for the mentioned predictor,and we found the CORE index had the largest areas under curves （0.986）,95% CI：0～1.000.CORE〉6 had a sensitivity of 92% and specificity of 96% in predicting SBT success.Conclusions The CORE index was the most accurate predictor of SBT success/failure in ventilated COPD patients.when CORE〉6,the SBT successful rate was high.