浅快呼吸指数、中心静脉血氧饱和度及其变化率对机械通气患者拔管成功率的预测价值

Forecast value of rapid-shallow-breathing index,central venous blood oxygen saturation and change rate of central venous blood oxygen saturation on the success rate of extubation in patients with mechanical ventilation

目的:探讨浅快呼吸指数(RSBI)、中心静脉血氧饱和度(SCVO_2)及其变化率(ΔSCVO_2)对机械通气患者拔管成功率的预测价值。方法:采用前瞻性研究方法,选取重症监护室的机械通气患者70例次,按拔管结果分成拔管成功(ES)组和拔管失败(EF)组,比较2组SCVO_2、ΔSCVO_2及RSBI。结果:2组患者性别、年龄差异无统计学意义(P>0.05)。2组自主呼吸试验(SBT)30min SCVO_2、ΔSCVO_2及RSBI差异有统计学意义(P<0.05)。SBT 30 min SCVO_2与拔管成功率正相关(r=0.283,P=0.025),ΔSCVO_2和RSBI与拔管成功率负相关(r=-0.425,-0.282,P=0.001,0.025)。SBT 30min SCVO_2、ΔSCVO_2和RSBI的ROC下面积分别为0.697、0.810、0.651。结论:SBT 30 min SCVO_2、ΔSCVO_2和RSBI对机械通气患者拔管成功率具有一定的预测价值,ΔSCVO_2、SBT 30 min SCVO_2优于RSBI。

Objective： To investigate the differences in the forecast value of rapid-shallow-breathing index （RSBI）, central venous blood oxygen saturation （ SCVO2 ） and the change rate of central venous blood oxygen saturation （ ASCVO2 ） on the success rate of extubation in patients with mechanical ventilation. Methods ： A perspective study was conducted. Sev- enty patients with mechanical ventilation in ICU were divided into two groups according to the extubation results. The differ- ences in SCVO2, ASC^O2 and RSBI were compared. Results： No significant differences were found in the items such as age and sex between two groups （P 〉 O. 05 ）. There were significant differences in SCVO2 of SBT at 30 min, ASCVO~ and RSBI between two groups （P 〈 O. 05）. There were correlations between SCVO2 of SBT at 30 min and the success rate of extubation （r = 0.283 ,P = 0. 025 ）. ASCVO2 and RSBI were correlated with the success rate of extubation negatively （r-- -O. 425, - O. 282, P = 0. 001, O. 025 respectively）. The area of SCVO2 of SBT at 30 min, ASCVO2 and RSBI under the ROC curve was 0.697, 0. 810 and 0. 651 respectively. Conclusion： There was certain forecast value of SCVO 2 of SBT at 30 min, ASCVO2 and RSBI to determine the success rate of extubation in patients with mechanical ventilation. The efficacy of ASCVO2 and SCVO2 of SBT at 30 min in predicting the success rate of extubation was superior to that of RSBI.