综合脱机指数、用力呼吸指数和气道闭合压与ARDS撤机患者病情及撤机结局的关系

Relationship of integrated weaning index,breathing hard index and airway occlusion Pressure to weaning outcome of ARDS patients

目的探讨综合脱机指数(IWI)、用力呼吸指数(CORE)和气道闭合压(P0.1)与急性呼吸窘迫综合征(ARDS)撤机患者病情及撤机结局的关系。方法选取2012年1月至2015年6月于我院进行气管插管机械通气治疗的ARDS患者86例为研究对象,行撤机筛查实验,符合条件者行30min自主呼吸实验(SBT),统计其撤机成功率,比较撤机成功和失败患者SBT前的IWI、CORE和P0.1,采用急性生理与慢性健康评分(APACHE II)评价同期病情,采用Pearson线性相关分析法分析IWI、CORE和P0.1与ARDS撤机患者APACHE II评分的关系,并采用Spearman无条件相关分析法分析IWI、CORE和P0.1与ARDS撤机患者撤机成功率的关系。结果 86例ARDS患者撤机成功率为72.09%,与撤机成功患者比较,撤机失败患者的IWI和CORE降低,P0.1和APACHE II评分则升高(P<0.05)。Pearson线性相关分析结果显示,IWI、CORE与ARDS撤机患者APACHE II评分均呈负相关(r=-0.993,-0.985,P<0.05),P0.1与ARDS撤机患者APACHE II评分则呈正相关(r=0.992,P<0.05)。Spearman无条件相关分析结果显示,IWI、CORE与ARDS撤机患者撤机成功率呈正相关(r=0.788,0.795,P<0.05),P0.1与ARDS撤机患者撤机成功率则呈负相关(r=-0.812,P<0.05)。结论 IWI、CORE和P0.1与ARDS撤机患者病情和撤机结局均密切相关,IWI、CORE和P0.1可能用于ARDS撤机患者撤机和病情评估,指导其治疗从而改善疗效。

Objective To evaluate the relationship between integrated weaning index （ IWI） , breathing hard index （ CORE） and airway occlusion pressure （ P0. 1 ） with weaning outcome of acute respiratory distress syndrome （ ARDS） patients. Methods 86 patients with ARDS and tracheal intubation and mechanical ventilation treatment in our hospital from January 2012 to June 2015 were selected as the research object and had weaning screening experi-ment. The patients qualified weaning screening experiment had 30 min spontaneous breathing test （ SBT） . The suc-cess rate of weaning were statistically analyzed, and IWI, CORE and P0. 1 before SBT of the weaning success and weaning failure were compared. Chronic health evaluation （ APACHE II） was applied in evaluation of illness severity in the same period. Pearson correlation analysis method was applied in analysis of the relationship between IWI, CORE and P0. 1 with APACHE II score of ARDS patients treated with ventilator. And unconditional Spearman corre-lation analysis was adopted in analysis of the relationship between IWI, CORE and P0. 1 with weaning success rate of ARDS patients treated with ventilator. Results The weaning success rate was 72. 09%. Compared with patients with weaning success, IWI and CORE of weaning failure patients reduced, while P0. 1 and APACHE II score of weaning failure patients increased （P〈0. 05）. Pearson correlation analysis showed that IWI, CORE and APACHE II score of ARDS patients treated with ventilator were negatively correlated （r= -0. 993, -0. 985, P〈0. 05）, while P0. 1 and APACHE II score of ARDS patients treated with ventilator was positively correlated （r =0. 992, P 〈0. 05）.Conclusion IWI, CORE and P0. 1 are closely related with illness severity and weaning outcome of ARDS patients. Therefore, IWI, CORE and P0. 1 can be applied in assessment of weaning outcome and illness severity of patients with ARDS, guiding the treatment and improving curative effect.