呼气峰流速测定对急性呼吸衰竭患儿撤机结果的预测价值

Value of peak expiratory flow determination for the prediction of machine withdrawal in children with acute respiratory failure

目的探讨咳嗽时呼气峰流速（PEF）值对预测急性呼吸衰竭患儿撤除呼吸机结果的价值。方法 2010年9月至2012年9月本市某三甲医院收治的85例重症呼吸衰竭机械通气患儿,男48例,女37例,年龄2~6岁,根据撤除呼吸机后48 h内是否需要进行气管插管分为成功组（71例）和失败组（14例）,比较2组患儿撤机前的一般临床资料、肺功能、血气分析指标及PEF值差异;计算ROC曲线下面积（Az）,评估PEF对患儿撤机结果的预测价值。结果撤除呼吸机前成功组与失败组患儿的基本资料：年龄、性别、小儿危重病例评分、病因并构成、合并下呼吸道感染率、机械通气时间比较差异均无统计学意义（P〉0.05）。撤机前成功组与失败组呼吸频率（RR）、心率（HR）、潮气量（Vt）、每分钟通气量（MV）、平均气道压（MAP）、血p H值、动脉血氧分压（Pa O2）、动脉血二氧化碳分压（Pa CO2）、氧合指数（Pa O2/Fi O2）比较,差异均无统计学意义（P〉0.05）;撤机前成功组患儿的PEF值为（46.3±8.2）L/min,显著高于失败组患儿的（37.6±7.4）L/min,差异有统计学意义（P〈0.05）。PEF预测撤机结果的Az值为0.890,预测撤机结果的最佳PEF值为40.6 L/min。结论 PEF值预测呼吸衰竭患儿撤机结果具有一定的准确性,可以作为临床上撤机的一个依据。

Objective To investigate the value of cough peak expiratory flow rate（ PEF） for the prediction of machine withdrawal in children with acute respiratory failure. Methods Eighty-five severe cases of acute respiratory failure in children were admitted into our hospital from September,2010 to September,2012,including 48 male and 37 female cases,with an age range of 2- 6years. In accordance with the necessity of endotracheal intubation 48 hours after removal of the ventilator,the patients were designated as the success group（ 71 cases） and the failure group（ 14 cases）. Differences in general clinical data,pulmonary function,blood-gas analysis results and PEF values before removal of the ventilator were compared between the 2 groups. The ROC curve was used to calculate Az value and evaluate the predicative value of PEF in the removal of the ventilator. Results With respect to the general medical data of the success and failure groups before removal of the ventilator,there was no statistical significance in age,gender,pediatric illness scores,causes of illness,rate of lower respiratory tract infection and mechanical ventilation time,when comparisons were made between the 2 groups（ P 0〉. 05）. No statistical significance could be noted in respiratory rate（ RR）,heart rate（ HR）,tidal volume（ Vt）,minute ventilation（ MV）,mean airway pressure（ MAP）,p H value,Pa O2,Pa CO2 and Pa O2/ Fi O2,before removal of the ventilator,when comparisons were made between the 2 group（ P 〉0. 05）. Before removal of the ventilator,PEF value of the success group was（ 46. 3 ± 8. 2） L / min,which was significantly higher than that of the failure group（ 37. 6 ± 7. 4） L / min,with statistical significance（ P〈 0. 05）. Az value used to predict the results of ventilator removal was 0. 890,and the optimal PEF value used for the prediction of ventilator removal was 40. 6 L / min. Conclusion PEF value used for the prediction of ventilator removal was accurate to some extent and could be used as a clinical evidence for ventilator removal.